' '■ 




GETTING READY 
TO BE A MOTHER 



'?&&&' 



THE MACMILLAN COMPANY 

NEW YORK • BOSTON • CHICAGO • DALLAS 
ATLANTA • SAN FRANCISCO 

MACMILLAN & CO., Limited 

LONDON • BOMBAY • CALCUTTA 
MELBOURNE 

THE MACMILLAN CO. OF CANADA, Ltd. 

TORONTO 




From the painting by Gari Melchers. 

THE CARESS 



THE BEGINNING 

"Where did I come from, where did you pick me up?" the 
baby asked its mother. 

She answered, half crying, half laughing, and clasping the 
baby to her breast : 

"You were hidden in my heart as its desire, my darling. 

"You were in the dolls of my childhood's games; and when 
with clay I made the image of my god every morning', I made and 
unmade you then. 

"You were enshrined with our household deity, in his worship 
I worshiped you. 

"In all my hopes and my loves, in my life, in the life of my 
mother you have lived. 

"In the lap of the deathless spirit, who rules our home, you 
have been nursed for ages. 

"When, in girlhood, my heart was opening its petals, you 
hovered as a fragrance about it. 

"Your tender softness bloomed in my youthful limbs like a 
glow in the sky before sunrise. 

"Heaven's fiist darling, twin-born with the morning light, you 
have floated down the stream of the world's life, and at last you 
have stranded on my heart, 

"As I gaze on your face mystery overwhelms me: you who 
belong to all who have become mine. 

"For fear of losing you I hold you tight to my breast. What 
maiiic has snared the world's treasure in these slender arms of 



mine 



p, 



From "The Crescent Moon" (child poems), by Rabindranath 
Tagore. 



GETTING READY 
TO BE A MOTHER 

A Little Book of Information and Advice for the Young 
Woman Who is Looking Forward to Motherhood 



BY 

CAROLYN COXAXT VAX BLARCOM, R.X. 

it 

AUTHOR OF "OBSTETRICAL XURSIXG," "THE MIDWIFE IX EHGLAXD 

Formerly Assistant Superintendent and Instructor in Obstetrical Nursing and the 

Care of Infants and Children at tin Johns Hopkins Hospital Training 

School for Nurses. Honorary Member of the Miduives-' Institute, 

England. 

WITH AN INTRODUCTION BY 

J. CLIFTON EDGAR. M.D. 

Emeritus Professor of Obstetrics and Clinical Midwifery in the Cornell University 
Medical Colli • g< : Consulting Obstetrician to Bellevue Hospital: Surgeon 
to the Manhattan Maternity and Dispensary; Consulting Obste- 
trician to the New York Maternity, Jewish Maternity 
and Greenwich General Hospitals. 

AND 

FREDERICK W. RICE. M.D. 

Associate Professor of Obstetrics. New York University and Bellevue Hospital 

Medical College; Attending Obstetrician to Bellevue Hospital: Assistant 

Surgeon to the Manhattan Maternity and Dispensary; Assistant 

Surgeon to St. Bartholomew's Clinic and Hospital. 



WITH SEVENTY ILLUSTRATIONS 

THE MACMILLAN COMPANY 
1922 

All Eights Reserved 



^ 



PRINTED IN THE UNITED STATES OF AMERICA 



^ 



e^ 6 



vJ-3 



Copyright, 1922, 
BY THE MACMILLAN COMPANY. 



Set up and electrotyped. Published December, 1922. 



DEC 13 72 



CU692365 



TO 

THE BABY, 

upon whose wellbeing 
depends the future 

OF THE RACE 



PREFACE 

The young woman who is looking forward to motherhood 
is very often torn by sharply conflicting emotions. Her 
eagerness to have a baby and her happy anticipations may 
be dimmed by fears and misgivings, by superstitious and er- 
roneous beliefs born of an ignorance that is little less than 
pathetic. A little information about physiological func- 
tions and an explanation of some of the facts of mother- 
hood prove to be very reassuring to the mystified, unin- 
formed young woman. 

There is, too, the immeasurably important question of 
the expectant mother's personal hygiene — the general 
scheme of her living in such a way as to promote her own 
and her baby's welfare — concerning which the average 
young woman is almost wholly ignorant. 

But the busy doctor, who gives of himself, impartially, 
to a large number of patients, often finds it difficult to dis- 
cuss with each one, in a leisurely, reassuring way, the facts 
that he would like to have her grasp, the misinformation 
he would like to dispel and the small but influential de- 
tails of her daily life that he wishes her to consider. It 
is just such simple information and such details of per- 
sonal hygiene that I have attempted to set forth in this 
little book, with the hope that it may help the expectant 
mother intelligently and confidently to do her part in mak- 
ing ready for the baby ; and to spend the period of her ex- 
pectancy in a happy frame of mind, free from haunting 
anxieties. And I have given some space to a description 
of the course of the baby's development in order that his 



xii PREFACE 

mother might have an abiding sense of his reality and his 
need of her protecting care from the very moment of his 
origin. 

In no sense does this book replace the doctor's care, for 
it is merely a composite of the advice abont simple, every- 
day little things which the majority of obstetricians give 
to the average, normal woman. I have stressed the fact 
that the first need of both mother and baby, from the be- 
ginning of pregnancy, is supervision by a physician and 
that such advice as these pages offer is of value only as it 
forms a part of his personal care. 

I have drawn information from "The Practice of Ob- 
stetrics," by J. Clifton Edgar, M. D. ; "Obstetrics," by J. 
Whitridge Williams, M. D. ; "The Prospective Mother," 
by J. Morris Slemons, M. D. ; " The Diseases of Infants 
and Children," by J. P. Crozer Griffith, M. D. and "The 
Newer Knowledge of Nutrition," by E. V. McCollum, 
Ph. D., Sc. D. I am deeply indebted to Dr. J. Clifton 
Edgar, Dr. Frederick W. Rice and Dr. John W. Harris for 
helpful advice and criticisms and to Miss Louise A. Scho- 
field for editorial assistance. Practical suggestions have 
been generously contributed by other doctors, and by 
nurses, in this country and Canada, whose effective work is 
inspired by their belief that the future welfare of our race 
depends upon the care given to-day to maternity patients 
and their babies. 

Carolyn Conant Van Blarcom. 

149 East 40th Street 
New York City 



INTRODUCTION 

The child-bearing function is a wonderfully complex 
physiological phenomenon. It affects and is influenced by 
almost every organ and tissue in the human body. 

The body of the female child from the earliest weeks of 
its life in its mother's womb, while receiving nourishment 
from her body, through infancy and the years of child- 
hood to maturity is being gradually molded and developed 
for the special carrying out of this one function — the 
crowning and most vital act of woman. 

Although the child-bearing function is the origin and 
source of the human race, existing throughout the ages, the 
processes connected with it have only in recent years been 
clearly understood. 

Our present-day knowledge of the processes connected 
with childbirth makes it easy to understand how, in the 
early ages of the human race, the function was a normal 
function, with little or no danger to mother or child. 
But with the gradual growth of the race, with the begin- 
ning of the struggle for existence and the appearance and 
spreading of disease, all interfering with the natural 
growth and development of the body, the function of child 
bearing ceased to be a normal function, as designed by 
its Maker, and became one fraught with dangers to both 
mother and child. Nevertheless, tli rough ignorance of these 
changes brought on by civilization, the idea that the func- 
tion is a normal process, the risk slight and fatalities in- 
frequent and when occurring, inevitable, is the almost uni- 
versal belief to-day. 

The dangers to the life of the mother and child in the 
carrying out of this function are well known to the medi- 



xiv INTRODUCTION 

cal profession, as well as the fact that for the most part 
they are preventable. Yet in spite of this knowledge, each 
year brings forth, unchanging, its toll in fatalities and 
countless numbers of invalid mothers, with the inevitable 
destroying factor of the happiness of the home. 

Statistics are available to show that less than half of all 
pregnancies are normal and that the illness and loss of 
human life, from causes associated with childbirth, are dis- 
tressingly and needlessly high. 

Failure to get these facts to the public ; failure to teach 
lay women the dangers to be avoided and the methods of 
protection, is one very important reason why there has 
been no decrease in the high mortality rates. 

During the past ten years, maternity hospitals and pri- 
vate and public health bodies, in various parts of the 
country, have obtained wonderful results, locally, in reduc- 
ing infant and maternal mortality, by giving to large 
groups of prospective mothers information concerning the 
common dangers associated with childbirth and how they 
might best be prevented. 

If every expectant mother, no matter what her status or 
location, followed the simple, practical advice which this 
book offers, the rate of illness and death among our mothers 
and babies would be materially lessened. 

This book, therefore, so complete in its information on 
every subject pertaining to the mother during pregnancy 
and confinement and of the care of the newborn infant, 
should be far reaching in its beneficial results. 

It is a book containing knowledge which every physician 
must admit that expectant mothers should have, and which 
a large number of expectant mothers are now earnestly 
seeking for their own protection and that of their newborn. 

J. Clifton Edgar, M. D. 
Frederick W. Rice, M. D. 

New York City- 
November, 1922 



CONTEXTS 



PAGE 

Preface xi 

Introduction, by J. Clifton Edgar, M.D., and Fred- 
erick W. Rice, M.D xiii 

CHAPTER 

I Getting Ready to Be a Mother 1 

II Signs that a Baby is Coming 11 

III Where the Baby's Life Begins 20 

IV How the Baby Develops Before He is Born . . . 34 
V Taking Care of the Baby Before He Comes ... 46 

VI Making Ready for the Baby 82 

VII The Baby's Arrival 98 

VIII The Baby 's Mother 114 

IX The Mother's Care of Herself — for the Baby's 

Sake 138 

X The Mother's Care of Her Baby 148 

XI The Nutrition of Mother and Baby 226 



LIST OF ILLUSTRATIONS 

• ' The Caress ' ' by Gari Melchers Frontispiece 

Chapter III. 

FIG. PAGE 

1. Diagram of pelvis 21 

2. Side view of female generative organs 23 

3. Front view of female generative organs 25 

4. Diagram of human ovum 26 

5. Front view of breast 32 

Chapter IV. 

6. Diagram showing process of cell division 36 

7. Diagram of baby, cord, membranes and placenta within the 

uterus 38 

8. Appearance of the baby at different stages of development 40 

9. Position of baby in the uterus just before birth ... 42 

CMpter V. 

10. Front and side views of maternity corsets 59 

11. Front, side and back views of homemade abdominal 

binder and breast bandage, applied 60 

12. Abdominal binder used in Fig. 11 61 

13. Front and back views of homemade stocking supporters . 62 

14. Right-angled position for relief of swollen feet and legs . 71 

15. Lying with hips elevated to relieve swelling of vulva . . 73 

Chapter VI. 

16. Leggings for use at the baby's birth 88 

17. Pad made of newspapers, to protect bed 90 

18. Pattern for baby's petticoat 92 

19. Pattern for baby's dress 93 

20. Outfit of satisfactory baby-clothes 94 

21. Baby 's toilet tray 96 

xvii 



xviii LIST OF ILLUSTRATIONS 

Chapter VII. 

FIG. PAGE 

22. Diagram showing cervix in process of being dilated . . 101 

23. Drawing showing descent of baby during birth .... 104 

24. Helping the baby to breathe . Ill 

Chapter VIII. 

25. Supporting heavy breasts with straight binder .... 118 

26. Supporting heavy breasts by means of three folded towels 119 

27. Indian binder for heavy breasts 120 

28. Protecting nipples with sterile gauze 121 

29. Position of mother and baby while nursing in bed . . . 123 

30. Using shield to protect sore nipples, while nursing baby . 124 

31. Nipple shield used in Fig. 30 125 

32 to 38, inclusive. Bed exercises 128 to 131 

39. Knee chest position 132 

40. Walking on all fours 133 

Chapter X. 

41. Baby's weight chart 151 

42. Diagram of first teeth 153 

43. Appearance of fresh cord immediately after birth . . . 154 

44. Appearance of cord four days after birth 155 

45. Appearance of navel after cord has dropped off . . . . 155 

46. Appearance of normal, well healed navel 156 

47. Preparing the baby's milk 169 

48. Position in which to hold baby and bottle for feeding . 172 

49. Holding baby upright after feeding to prevent colic . . 173 

50. Putting the baby into his bath 185 

51. Supporting the baby's head above water while giving bath 186 

52. Dry, sterile cord dressing 189 

53. Flannel band over cord dressing 190 

54. Putting on the straight diaper 191 

55. The diaper in Fig. 54 applied 192 

56. The Sutton poncho 198 

57. Method of carrying baby to support back and head . . 200 

58. Training the baby to use a chamber 202 

59. Elbow cuffs to prevent thumb-sucking 203 

60. Immersing baby for bran or mustard bath 209 



LIST OF ILLUSTRATIONS xix 

PIG. P-iGE 

61. Putting the baby into a wet pack 210 

62. The baby in a wet pack 211 

63. Diagrams showing successive steps in giving pack . . . 212 

64. Giving the baby an enema 217 

65. Quilted robe for the premature baby 220 

66. Bed for premature baby improvised from a clothes basket 22] 

67. The baby in a basket, ready to travel 224 



GETTING READY 
TO BE A MOTHER 



CHAPTER I 
GETTING READY TO BE A MOTHER 

How does it seem to you — the coming of a baby ? 

Does it seem the most amazing of miracles, so stirring in 
its beauty and mystery that you are eager to make ready 
and prepare for it fitly? 

Or have you, perhaps, come to share the general feeling 
that motherhood is a natural state which one accepts when 
it comes, but need not prepare for? 

This attitude seems to go back to a very old and deeply 
rooted conviction that, as women always have had babies 
and have had them through the working of one of Nature 's 
laws that has been operating over and over throughout the 
ages, they doubtless will continue to have them in the same 
old way, and the entire matter may well be left to take 
care of itself. As to the baby, when he comes, one may 
expect that the ability to care for him will come too. 

Because of this reasoning, or lack of it, it has been a 
fairly general custom for the woman who expected a baby 
to seek her doctor's aid only when she went into labor, or 
shortly beforehand, and to give no thought to the care of 
her baby until he was born. All too often the mother has 
died, because of this tardy care, been injured or become an 
invalid, while equally sad things have happened to the baby 
— and needlessly so. 

But now, happily, a great change is taking place in the 
realm of mothers and babies. We still realize, of course, 
that childbearing is a natural function, but we know that 
conditions must be made favorable for the smooth working 

1 



2 GETTING READY TO BE A MOTHER 

of this natural law if all is to be well ; that for the sake of 
both mother and baby it is of urgent importance to 
give thought and care to the baby during the nine months 
before he is born. 

There is little doubt that the most critical period in one 's 
life is the first ten months — the nine months before birth 
and the first month afterward — and that the care which is 
given during these months influences one's physical state, 
for good or ill, throughout all the rest of life. In the light 
of this knowledge, women are more and more generally 
seeking and being given " prenatal care," which is care 
before the baby is born, together with advice and instruc- 
tions which fit them to assume motherhood safely and suc- 
cessfully. 

Ideal prenatal care would really begin during the ex- 
pectant mother's own infancy, for the chances of a normal 
pregnancy, labor and lying-in period are greatly increased 
by good care during the early years of life. But for the 
time being we shall have to content ourselves with an ef- 
fort to extend, as widely as possible, the care that is now 
known to be beneficial for expectant mothers from the be- 
ginning of pregnancy. 

This prenatal care is undertaken in much the same spirit 
in which one makes a garden, for example. We know, of 
course, that plants which are neglected sometimes grow 
and blossom satisfactorily, though one would not think of 
depending upon them to do so. But we have learned that 
plants that are given the care and protection that they 
need are almost certain to flourish and bloom after the 
manner of their kind. 

Experience teaches, however, that this care must be 
regular and sustained and always given for the twofold 
purpose of preserving the plants from injury as well as 
nourishing them. Accordingly we put them in good soil, 



GETTING READY TO BE A MOTHER 3 

to begin with, and then give water, sunshine or shade, ac- 
cording to their respective needs, and we take care to pro- 
tect them from the destructive effects of harmful insects, 
blights, weeds or anything which may be unfavorable to 
their healthy progress. We do not close our eyes to the 
fact that these harmful conditions are possible. Instead, 
we are anxious to find out all about them — what causes 
them and how to recognize them — in order that we may 
prevent or remove them before they do serious damage. 

Many women, nowadays, are taking just that kind of 
attitude toward motherhood. They begin by consult- 
ing a doctor as soon as they know that they are pregnant, 
because they appreciate the importance of doing so. They 
study eagerly the questions relating to motherhood; the 
structure and workings of those parts of their own bodies 
which are concerned with the baby's creation; how he 
evolves within them; what he needs during those nine 
months of development; what practices, what conditions 
are bad for the baby and themselves ; what they can do to 
avoid or correct these and how they can help to make 
things go smoothly. 

The women who face the facts of motherhood in this 
way generally go through the entire adventure normally 
and successfully, as Nature intended they should. More 
than this, those women who place themselves under a doc- 
tor's care from the beginning of, or early in, pregnancy, 
are greatly reassured to find out how much can be done 
to safeguard them, and they do not have that fear of the 
approaching birth which is suffered by so many women 
who do not know nor understand what is going on. 

The results of the painstaking work and study which 
have been carried on to increase the comfort and safety 
of mothers and babies have made it possible for the doc- 
tors to plan something of a routine which they find ad- 



4 GETTING READY TO BE A MOTHER 

visable for their patients to adopt. To begin with, it is 
quite plain that the first need of every expectant mother 
is examination and measurement, early in pregnancy, by 
a good physician. The information thus obtained helps the 
doctor to foretell the kind of labor that his patient is likely 
to have, and by planning for it ahead of time he is often 
able to save her much harm and suffering. An early ex- 
amination also enables the doctor to discover and correct 
any slight trouble which may exist at that time and which 
might grow worse if not treated, and to advise his patient 
about the general care which he wishes her to take of her- 
self throughout pregnancy. In regard to this care, doc- 
tors are generally agreed that the average woman needs 
to do little more than observe the ordinary rules of personal 
hygiene, which as a matter of fact, should be followed by 
all of us ; that is, she should live a simple, regular life as to 
diet, fresh air, exercise, rest, sleep, diversions, etc. This 
all sounds simple enough and as a matter of course, but 
it is usually overlooked in spite of being of the most ur- 
gent importance to both mother and baby. 

This advice varies in little things, here and there, among 
different doctors, but in the main it is about the same the 
world over, where thought is being given to the care of 
expectant mothers. For no matter where they are or what 
their status, their needs in general are the same. They 
need a doctor's supervision and they need to practice the 
principles of personal hygiene. 

Accordingly, in addition to making an early examina- 
tion and giving instructions about the regulation of her 
daily life, the doctor usually wants to see his patient and 
make certain observations every little while during preg- 
nancy, just to make sure that everything is going as it 
should and to be in a position to discover the earliest and 
slightest symptoms of complications. 



GETTING READY TO BE A MOTHER 5 

In the old days there were certain complications asso- 
ciated with childbirth which the doctors did not know how 
to prevent and sometimes could not cure — complications 
which were bad for both mother and baby. But now they 
know a great deal about both preventing and curing even 
the most serious of these complications. They have discov- 
ered, for one thing, that many conditions which give seri- 
ous trouble during labor, or soon afterwards, actually have 
their beginnings during pregnancy, and sometimes very 
early. 

Quite evidently, then, it means a great deal to the ex- 
pectant mother to have the doctor discover and treat these 
complications before they have had time to become serious. 
But he can give early treatment only if he knows about the 
symptoms of the trouble when they first appear. Some of 
these symptoms may be detected by the expectant mother 
herself after they have been explained to her, but some 
of them can be discovered only by a doctor or a nurse. 
That is why it is important for the doctor to see his patient 
at frequent intervals during pregnancy; about once a 
month during the first half and every two weeks after- 
wards. 

He sees her for much the same reasons that the house- 
wife looks over the contents of her darning basket — not 
once and for all time, but regularly, once a week, over and 
over and over. She searches each time not for holes alone, 
but for thin places, too ; an occasional broken thread or the 
beginning of a " run, ' ' knowing how much trouble she will 
save herself, later on, by promptly repairing the smallest 
break or evidence of wear. She knows quite well that there 
are no more holes because she looks for them, than there 
are if she does not, and that failure to look for them will 
not keep the holes from being there nor from growing larger. 
No more does the expectant mother develop a complica- 



6 GETTING READY TO BE A MOTHER 

tion because she is examined, nor does an existing condi- 
tion cease to exist because she is not examined; and yet 
some women still take just that illogical attitude toward ex- 
aminations and supervision during pregnancy. 

One factor which keeps some expectant mothers from 
seeking medical care is the well meaning but dangerous 
counsel so freely offered by older women who claim fitness 
to advise by virtue of having had several children of their 
own. Their lack of success, as evidenced by miscarriages, 
stillbirths, children dying in early infancy, as well as in- 
juries and disabilities of their own, is usually overlooked 
as they press their superstitions and remedies upon the in- 
experienced and bewildered younger woman. When dis- 
aster follows, as it so often does, it is very likely to be as- 
cribed to the will of God, and the mother's needless sacri- 
fice does not even serve as a warning to others who are 
in line for the same kind of advice. 

Another obstacle to adequate prenatal care is sometimes 
found in the husband who considers it entirely reasonable 
to secure expert advice upon the subject of cattle-raising, 
let us say, or the care and running of his automobile or 
about his investments, but who has a conviction that it is 
normal and natural for women to have children without 
making what he considers a fuss about it. He may cher- 
ish, too, a suspicion that it is not altogether good for his 
wife to be thinking too much about her condition. His 
mother never began bothering until the baby came. 

On the other hand, many husbands show the tenderest 
solicitude for their wives throughout pregnancy and would 
be only too eager to have them enjoy all the benefits of 
prenatal care, if they only knew and understood about it. 
The expectant mother will be wise, therefore, if she under- 
takes to convince her husband, if need be, that her occupa- 
tion of bearing and rearing children merits quite the same 



GETTING READY TO BE A MOTHER 7 

thoughtful attention as his work, to which he devotes his 
best powers. 

How easy and worth while this may be was demonstrated 
a couple of years ago at a county fair which was attended 
by a very intelligent farmer and his wife. The farmer 
was interested in hog-raising and both he and his wife ac- 
cepted without question the fact that success in this enter- 
prise could be achieved only through serious study and the 
most painstaking care. But as to childbearing, if they 
thought of it at all, they looked upon it as simply one of 
those natural functions which always had and doubtless 
always would take care of itself. 

When this couple reached the fair the farmer entered 
one of his fine animals in a prize-winning contest and as 
there was a baby contest, too, the wife entered their little 
son. In due time the judges inspected the various con- 
testants and it was found that point by point the farmer 's 
hog measured up to all of the standards of perfection for 
his kind and easily won the first prize. Not so with the 
baby; point by point he fell below even a moderate aver- 
age of what a baby should be and was outranked by many 
of his more robust infant competitors. 

As various admirers discussed hog-raising with the 
farmer, it became quite evident that he had carefully 
studied the question and had applied to his occupa- 
tion the most approved methods of which he could learn. 
But when the doctors and nurses at the baby contest talked 
with the crestfallen mother about her baby, who had seemed 
right enough to her, they found that she knew little or noth- 
ing of the business of being a mother; that it had never 
occurred to her nor to her husband that she might profit 
by care and instruction about herself and her baby both be- 
fore and after he was born. As might be expected, she 
had been unable to nurse him and on the whole he proved 



8 GETTING EEADY TO BE A MOTHER 

to be a pretty poor specimen of a baby, with a dismal out- 
look as to health. 

Since the mother was then in an early stage of another 
pregnancy, the doctor talked it all over with her and her 
husband. He convinced them that such thoughtful and 
painstaking care as they had devoted successfully to hog- 
raising were equally effective* when applied to baby-raising. 
As a result, the expectant mother, with her husband's 
whole-hearted approval, placed herself under the care and 
supervision which she found were available through a pre- 
natal clinic in her vicinity. 

The happy sequel to that story is that when another 
fair was held, a year later,, the farmer entered another 
one of his hogs and the wife her new baby, and that this 
baby held his own with the hog by taking a prize, too. 

So sincerely do doctors now believe in the urgency of 
having all maternity patients under supervision and care 
during the nine months before the baby comes and the 
first several weeks afterwards, that they not only care for 
those women who come to their offices, but also give of their 
knowledge and skill to organizations engaged in prenatal 
and maternity work. These organizations may be visiting 
nurse associations, prenatal clinics, health centers or dis- 
pensaries. As the doctors are assisted by nursing staffs 
they are able to offer protection, through these channels, 
to a very large number of mothers and babies. 

Among the women who are cared for by such organiza- 
tions, or by doctors in their private practice, there is an 
enormous reduction in the occurrence of convulsions, for ex- 
ample, abortions, miscarriages, stillbirths, infections (child- 
bed fever), and prolonged and difficult labors. Or, to put 
it the other way round, good care started during early 
pregnancy and continued throughout labor and the lying-in 
period gives both mother and baby enormously increased 



GETTING READY TO BE A MOTHER 9 

chances to live and enjoy good health. One reason why 
the baby is so much better off is that good care practically 
always enables his mother to nurse him, for, except in ex- 
tremely rare cases when there is a definite physical dis- 
ability, as tuberculosis for example, every mother can nurse 
her baby if she really wants to and if she, the doctor and 
nurse bend all their energies to accomplish this happy 
end. A baby who is not breast-fed is defrauded of a pro- 
tection which is rightfully his, and usuallj' because some- 
one has failed to do all in his or her power. 

Organizations which include doctors and nurses who can 
give skilled care to maternity patients are increasing in 
scope and number throughout cities, towns and rural dis- 
tricts in all parts of the country. This makes us hope that 
before long good care during pregnancy, childbirth and 
young motherhood will be available to every woman in 
the land. But quite as earnestly do we also hope that 
every woman in the land who is looking forward to mother- 
hood will seek this care. Certain it is that the expectant 
mother who does seek care, whether from a doctor in his 
office or through a prenatal clinic, is approaching her 
motherhood in the only way that is safe for herself and 
her baby. She should realize, however, that although the 
doctors can accomplish a great deal through examinations 
and advice, they can give the full benefits of their skill 
only to those women who do their part by following in- 
structions faithfully, week after week, throughout nine 
months. The doctor cannot live his patient's life for her; 
he can plan and advise her ever so wisely, but this counts 
for very little unless she lives as he directs. 

The young woman who sees her motherhood as a coveted 
privilege, crowded with happy possibilities, who is will- 
ing to bear its inconveniences and take the necessary pre- 
cautions to insure a satisfactory outcome, is very likely to 



10 GETTING READY TO BE A MOTHER 

go through her experience in good health and buoyant 
spirits. And in the end she will have not only the ecstasy 
of possessing a beautiful, well baby who has every 
prospect of continuing so, but as the years pass she will 
have the satisfaction of knowing that she is a better, more 
helpful, more companionable mother because of being in 
good health herself. 

That is the point of good maternity care — future well- 
being as well as immediate safety for both mother and baby 
— and it rests with each woman to decide for herself if she 
is to have such care. 



CHAPTER II 
SIGNS THAT A BABY IS COMING 

The woman who wants a baby and is in a position to have 
cne is usually eager to know how she can tell when a baby 
is coming-. She wants to know because the baby's coming 
means so much to her and also in order that she may know 
when to consult a doctor. 

I am sorry to have to admit, at the outset, that making 
this important discovery is far from being a simple mat- 
ter. One would suppose, after all these ages, during which 
countless babies have been born and countless pregnancies 
have been observed by doctors and others, that there would 
be some known way of finding out definitely, at an early 
date, whether or not a baby was coming. But strangely 
enough, there is no positive evidence of the baby 's existence 
within his mother's body until eighteen or twenty weeks 
after his life there lias begun. 

On the other hand, so many symptoms of pregnancy 
are known to women, the world over, that very often an ex- 
pectant mother is correct when she suspects at an early 
date that she is pregnant, particularly if she has already 
had a child. But as the well-known symptoms are much like 
those of various conditions other than pregnancy, even ex- 
perienced mothers sometimes believe themselves pregnant 
when they are not. The reverse is true also, for we occa- 
sionally hear of a woman who fails to recognize the meaning 
of the changes which she notices in herself, and is unaware 
of being pregnant up to the very time of going into labor. 

11 



12 GETTING READY TO BE A MOTHER 

And so we find that there are some signs of pregnancy 
which are only possible, since they may be caused by some 
other conditions ; others which may be accepted as probable, 
and a few signs which are positive because they are never 
due to any cause but pregnancy. 

The possible signs can all be detected by the expectant 
mother, herself, and may be described as follows : 

1. Stopping of Menstruation. This is usually the first 
symptom noticed. Although it is possible for the periods 
to be stopped by any one of several other causes, the miss- 
ing of two successive periods, after intercourse, is a strong 
indication of pregnancy in a healthy woman of the child- 
bearing age, whose menses have been regular. 

2. Changes in the Breasts. These, also, occur early. 
The breasts usually increase in size and firmness, and many 
women complain of throbbing, tingling or pricking sensa- 
tions and a feeling of tightness and fullness. The breasts 
may be so tender that even slight pressure is painful. The 
nipples become larger and more prominent; they and the 
colored circle of skin around them grow darker, while the 
veins and the glands that feel like little lumps under the 
skin become more noticeable. If, in addition to these symp- 
toms, it is possible for a woman who has not had children 
to squeeze from her nipples a pale yellowish fluid, called 
colostrum, she may feel almost certain that she is preg- 
nant. But it must be remembered that these symptoms, 
also, may be due to causes other than pregnancy; that 
even milk in the breasts may be present in a woman who 
has borne children, for months, or possibly years, after the 
birth of her last baby. 

3. "Morning sickness," as the name suggests, is nausea, 
sometimes accompanied by vomiting, from which many ex- 
pectant mothers suffer the first thing in the morning. This 
varies from a little nausea, when first raising her head, 



SIGNS THAT A BABY IS COMING 13 

to repeated attacks of vomiting during the day and even 
during the night. As a rule, however, the discomfort is 
experienced during the early part of the day only. Morn- 
ing sickness may set in immediately after conception, but 
begins about the sixth week, as a rule, and lasts until the 
third or fourth month. It occurs in about half of all preg- 
nancies and is particularly common among women who are 
pregnant for the first time. On the other hand, one must 
not forget that many non-pregnant women suffer from nau- 
sea in the morning; many women go through pregnancy 
without any such disturbance, while others are entirely 
comfortable in the morning but nauseated during the lat- 
ter part of the day. 

4. Frequent Urination. There is usually a desire to 
pass urine frequently during the first three or four months 
of pregnancy, after which the tendency disappears, but re- 
turns during the later months. The desire may be due in 
part to nervousness, but is largely caused by pressure 
made upon the bladder by the growing baby, and not by 
kidney trouble, as is sometimes believed. For pressure on 
the outside of the bladder gives much the same sensation 
as is experienced when the bladder is full of urine. After 
the baby grows to such a size that he pushes up into the 
abdomen (we shall describe this later), he does not press 
upon the bladder and therefore ceases to create a desire to 
urinate until the last month or six weeks before he is 
born when he sinks back into the pelvis. 

5. Increased discoloration of the colored parts of the 
skin is another early symptom of pregnancy. In addition 
to the deepened tint of the nipples and the circles around 
them, a dark streak appears upon the lower part of the 
abdomen, extending upward toward the umbilicus, or navel. 
There are also the yellowish, irregularly shaped blotches 
which sometimes appear upon the face and neck; dark cir- 



14 GETTING READY TO BE A MOTHER 

cles under the eyes and pinkish or bluish streaks on the 
abdomen. 

6. "Quickening" is the name which is commonly given 
to the mother's first feeling of the baby's movements. It 
occurs about the eighteenth or twentieth week, and is re- 
garded by some doctors as a positive sign of pregnancy and 
by others as merely a possible sign. The sensation is com- 
pared to a very slight quivering, or tapping, or to the flut- 
tering of the wings of a bird as it is held in one's hand. 
Beginning very gently, these movements grow more vigor- 
ous, as time goes on, until they become very troublesome to- 
ward the latter part of pregnancy, amounting then to sharp 
kicks and blows. Women who have had children can usu- 
ally distinguish between quickening and the somewhat simi- 
lar sensation caused by the movement of gas in the intes- 
tines; but a woman pregnant for the first time may be 
deceived. 

There are many other possible symptoms of pregnancy, 
but their value is very uncertain and as we have seen, even 
the ones described above are not entirely dependable. But 
if you have missed two periods ; if your breasts have grown 
larger and firmer; if your nipples are stiffer and more 
prominent and you can squeeze colostrum from them, you 
may be reasonably certain that a baby is coming. 

The probable signs of pregnancy are more apparent to 
the doctor than to the expectant mother, but there are two 
which you may easily detect : ' 

1. Enlargement of the abdomen, which is a very impor- 
tant sign, may be noticed about the third month. At this 
stage a rounded mass may be felt in the abdomen which 
steadily increases in size as the weeks and months slip by. 
Rapid enlargement of the abdomen in a woman of child- 
bearing age may be taken as fair, but not positive, evi- 
dence that she is carrying a baby. However, complete re- 



SIGNS THAT A BABY IS COMING 15 

liance cannot be placed in this sign, since it is possible for 
the abdomen to be enlarged by a tumor, by dropsy, or 
by fat. 

2. Painless contractions of the uterus (or womb, within 
which the baby lies) begin during the early weeks of preg- 
nancy and occur at intervals of five or ten minutes 
throughout the entire period. The expectant mother may 
not be conscious of these contractions during the early 
months, but later she can detect them by placing her hand 
upon her abdomen and feeling the uterus, beneath it. grow 
first hard and then soft, as it contracts and relaxes. But 
the probable signs of pregnancy, like the possible symp- 
toms, may occur in women who are not pregnant, and ac- 
cordingly the appearance of any one of them alone, is not 
of great significance. 

The positive signs of pregnancy, of which there are three, 
are not apparent until the eighteenth or twentieth week. 
They relate to the baby, but with one exception they can- 
not be detected by the expectant mother. However, they are 
of such moment that you will be interested to know what 
they are. 

1. Hearing and counting the baby's heart beat is un- 
mistakable evidence of the baby's existence. The doctor 
sometimes hears this by resting his ear upon the mother's 
abdomen and sometimes by listening through a stethoscope. 

2. Ability to feel the outline of the baby's body is also 
a positive sign of pregnancy, it' the head, buttocks, back 
and extremities are unmistakably made out through the 
mother's abdominal wall. 

3. Feeling the movements of the baby is accepted as a 
third positive sign of pregnancy. There is some difference 
of opinion concerning the value of "quickening/' alone, as 
a positive sign, but if the baby's movements are felt by 
the doctor, also, through the mother's abdominal wall, or 



16 GETTING EEADY TO BE A MOTHER 

by vaginal examination, there can be no doubt that a 
baby is there. Peeling; these movements some time after 
the eighteenth or twentieth week, by placing a hand upon 
the abdomen, is the one positive sign which the expectant 
mother may detect for herself. 

Some Other Changes in the Mother's Body While the 
Baby Grows. In addition to the signs and symptoms 
which we have just described, there are a good many other 
changes which will take place in your own body, in the 
course of the baby's development, and you will want to 
learn about some of them in order that you may know 
what to expect. 

The abdomen. Of course, the steady enlargement of the 
abdomen and the alteration in its shape, as pregnancy ad- 
vances, is the change that you will be most conscious of. 
As the abdomen grows larger, the skin which covers it is 
stretched more and more tightly with the result that the 
tissues just under the surface sometimes give way, or split 
and form pale pink or bluish streaks. These streaks, which 
are called strice, grow white and glistening after the baby 
is born, so that the abdomen of an expectant mother who 
has had children, will show silvery streaks from earlier 
pregnancies and also the bluish ones recently formed. 
These streaks are of no consequence and I mention them 
simply because you are almost certain to notice them and 
may wonder what they are. They may appear upon the 
hips, thighs and breasts as well as upon the abdomen, if 
the skin over these parts is greatly stretched. 

The umbilicus (navel) is deeply indented during about 
the first three months of pregnancy, but afterwards the pit 
steadily grows shallower and by the seventh month, it is 
level with the surface of the abdomen. After this time the 
navel may protrude, in which state it is described as a 
"pouting umbilicus." 



SIGNS THAT A BABY IS COMING 17 

An increase in the vaginal discharge is another change 
which you may notice during the latter months of preg- 
nancy. 

The changes in the skin consist chiefly of the increased 
discoloration over various parts of the body, which was 
mentioned among the possible signs of pregnancy. The 
degree of this discoloration varies with the complexion of 
the individual, as blonds may be tinted but slightly more 
than usual, while the discolored areas on a brunette may 
become almost black. As the skin glands become more ac- 
tive, there is also an increase in perspiration and sometimes 
the hair becomes much more luxuriant during pregnancy. 

Changes in the digestive tract are the morning sickness 
already described, and constipation. The latter is suffered 
by at least one half of all pregnant women and is due 
chiefly to pressure made upon the intestines by the en- 
larged uterus, though weakening of the stretched abdom- 
inal muscles may be one cause. Constipation is most 
troublesome during the latter part of pregnancy. There 
may be, also, heartburn, acid stomach and intestinal indi- 
gestion giving rise to gas, diarrhea and cramps. The so- 
called "cravings" of pregnancy are not so common in real 
life as they are in rumor, but the expectant mother may 
show unexpected likes and dislikes for certain dishes, pos- 
sibly because of her tendency to be nauseated. Her ap- 
petite may be very capricious during the early weeks and 
become almost ravenous later on. 

The bones and teeth may grow softer during pregnancy, 
if the expectant mother does not eat proper food, and as a 
result we hear of the old beliefs that each baby costs the 
mother a tooth and that broken bones heal slowly during 
pregnancy. Both of these occurrences are entirely un- 
necessary, and may be prevented by eating suitable food, 
as will be explained in the chapter on nutrition, 



18 GETTING READY TO BE A MOTHER 

The carriage, or mode of walking, is somewhat affected 
bj^ pregnancy because of the increased size and weight of 
the abdomen. In an effort to hold herself erect, the expect- 
ant mother throws back her head and shoulders and finally 
assumes a gait that may be described as a waddle, being 
particularly noticeable in short women. 

You hear a good deal about the thyroid gland these 
days, so you may as well know that it is very often enlarged 
during pregnancy and thus may form a swelling on the 
front part of the neck. If you notice it you might tell 
your doctor but it need not worry you for it will almost 
certainly return to its normal size after the baby comes. 

When to Expect the Baby. Now that you are familiar 
with the most apparent changes which will take place in 
your body during pregnancy, you are probably on tiptoe 
to find out as nearly as possible the date upon which to ex- 
pect the baby. Unfortunately we cannot foretell the exact 
date, for the very simple reason that we have no way of 
knowing just when pregnancy begins. Quite evidently, 
then, not knowing when it begins we cannot figure out the 
exact date upon which pregnancy will end in the baby's 
birth. But we do know that labor usually begins about 
ten lunar months, or forty weeks, or from 273 to 280 days, 
after the beginning of the last menstrual period. Thus 
the approximate date of the baby's arrival may be esti- 
mated by counting forward 280 days or backward 85 days 
from the first day of the last period. Or, what is perhaps 
simpler and amounts to the same thing, one may add seven 
days to the first day of the last period and count back 
three months. For example, if the last period began on 
June 3, the addition of seven days brings us to June 10, 
while counting back three months from this, indicates 
March 10 as the approximate date upon which the baby 
may be expected. 



SIGNS THAT A BABY IS COMING 19 

This is probably as satisfactory as any method of estima- 
tion, but at best it is only approximate, being accurate in 
about one case in twenty. However, it comes within a week 
of being correct in half the cases ; and is within two weeks 
of the actual date in eighty per cent, of all pregnancies. 

Still another method is to count forward twenty or 
twenty-two weeks from the day upon which you first feel 
the baby move. This "quickening," as we have seen, 
usually occurs about the eighteenth or twentieth week, but 
is so irregular that it is not wholly reliable. The possibility 
of figuring out the date of the baby's arrival is made still 
more uncertain by the fact that there is evidently consid- 
erable variation in the length of entirely normal preg- 
nancies. Many healthy children are born before ten lunar 
months have elapsed since the last menstrual period, while 
more births occur after than on the expected date. The 
first pregnancy is usually shorter than later ones, and 
women who are well nourished and well cared for usually 
have longer pregnancies than those who are not. 

Taking it as a whole, the average woman has unusually 
good health during pregnancy. She may feel some weari- 
ness during the first few months and she may lose a little 
weight, but during the latter part of the period her general 
health is improved and there is an increase of flesh, not 
alone in the abdomen, but over the entire body, sometimes 
amounting to twenty-five or thirty pounds. She loses 
about fifteen pounds of the increased weight when the baby 
is born, and still more during the weeks immediately fol- 
lowing, when her body returns to about its original condi- 
tion. But very often the experience of pregnancy is so 
beneficial that the improved state of health and nutrition 
which accompany it become permanent. 



CHAPTEK III 
WHERE THE BABY'S LIFE BEGINS 

As you plan for the care of your baby during the nine 
months before he is born, you will want to know something 
of the place where his life begins ; where one tiny cell is so 
miraculously stimulated and nourished that it finally de- 
velops into a beautiful little body. Not only will you 
find all of this of absorbing interest, but a general idea 
of the structures and workings of those parts of your body 
where the baby lives and grows will help you better to un- 
derstand some of the doctor 's precautions and to give your- 
self intelligent care while your body performs its supreme 
function. 

To begin with, there is the pelvis. This is a very ir- 
regular, bottomless, bony basin, or curved canal, within 
which lie the reproductive or generative organs to be de- 
scribed presently. The pelvis is really composed of four 
bones which are entirely separate in early life but firmly 
welded into one rigid structure in adults. I mention this 
because many women believe that labor pains are caused 
by a spreading or opening of these bones, whereas, as we 
shall see presently, the pains are really due to the strong 
contractions of the muscles of the uterus (or womb) in 
which the baby lies, which force the baby down through 
this inflexible ring. You may see in Fig. 1 how the pelvis 
is placed in the body, being interposed between the spinal 
column, which it supports, and the thighs upon which it 
rests, "We can feel two of its prominent points on either 

20 



WHERE THE BABY'S LIFE BEGINS 



21 



side below the waist, as our hips, and we rest upon two 
other projections while in the sitting position. 

This bony canal is drawn in, or narrowed about mid- 
way in its length so that it is broader above and below 
than it is in the middle. You are likely to hear the doc- 
tors speak of this narrow part as the inlet. I thought you 



Spinal __& 
colutrm 



False Jff^rr 

pelvis' J/J 




_ False 



FlG. 1. — Diagram showing the structure of the pelvis and its position 
in the body, the inlet being heavily outlined. 



would be interested to know about this for it is largely in 
order to discover the size and shape of the inlet that the 
doctor is so anxious to make certain examinations and meas- 
urements. 

The wide part of the pelvis above the inlet is called the 
upper, or false pelvis, while the smaller cavity below is 
known as the true pelvis. During the early part of preg- 
nancy the baby lies in the true pelvis, but as pregnancy 



22 GETTING READY TO BE A MOTHER 

advances and he grows larger, he pushes up through the 
inlet into the larger pelvis where he remains until he is 
born. When that time comes he must pass down through 
the inlet again on his way into the world. If this opening 
is about the usual size and shape and the baby is of an aver- 
age size, he will usually pass through with comparatively 
little trouble. But if the inlet is smaller than normal or of 
an unusual shape, it may be difficult, or even impossible, 
for the head of a normal-sized baby to pass through with- 
out the doctor's assistance. You can see how important it 
is, therefore, for the doctor to know beforehand about the 
size and shape of the pelvic inlet, since it enables him to 
plan to help with the birth, if necessary, thus saving mother 
and baby from exhausting themselves in trying to do the 
impossible. In the old days many mothers and babies were 
injured, and sometimes even lost their lives, because doctors 
did not know about measuring the pelvis and planning 
ahead of time for a difficult labor. But now they know 
how to make things easier and safer. 

It is worth mentioning here that proper care during in- 
fancy and childhood, with proper food, fresh air and exer- 
cise, helps to promote normal development of the pelves of 
little girls, and this in turn tends to make childbirth nor- 
mal for these children when they grow up and are ready 
to have babies of their own. 

The Generative or Reproductive Organs. The pelvis is 
an interesting structure but not nearly so interesting as 
the generative organs which lie within it: the uterus (or 
womb), tubes and ovaries. These, with the vagina, are of- 
ten called the internal genitalia because they are inside the 
body. The pelvis practically remains rigid and inactive 
throughout pregnancy and labor, but the ovaries and the 
uterus are constantly active and are concerned with an un- 
dertaking which is so utterly amazing that it is far beyond 



WHERE THE BABY'S LIFE BEGINS 



23 



our powers of understanding. We can only look on and 
wonder. 

The uterus, or womb, in which the baby develops, is a 
firm little mass of muscle, which, in its non-pregnant state, 
is much the shape of a slightly flattened pear, about three 



Top of 



"Uttrlue 



"Uterine _A 
Bone — ~~" 

y 

Bladder - ' K 




Operm\^/ 
■from Wilder 



««Bfcc\<. bone 



r-i-Cerv\X 



»-Rectur^ 



^U6 



rWrneuYrx 



Fig. 2. — Drawing showing the structure and relation of the female 
generative organs, as viewed from the side. (Drawn by Max BrodeL 
Used by permission of A. J. Nystrom and Co., Chicago.) 



inches high, an inch and a quarter wide at its broadest 
point, three quarters of an inch thick, and weighs about 
two ounces. We usually speak of the main part of the 
uterus as the body; the round top as the fundus and the 



24 GETTING READY TO BE A MOTHER 

smaller part of the organ, below, as the neck or cervix. 
This important little organ is placed about the middle of 
the true pelvis, with the upper end pointing slightly for- 
ward. (See Fig. 2.) It is more or less swung in this posi- 
tion by being attached to ligaments instead of to any fixed 
part, the ligaments, in turn being attached to the sides of 
the pelvis. This explains why the uterus may move about, 
tip forward or backward, and how, by a stretching of the 
ligaments that hold it, it is able to grow and push upwards 
as pregnancy advances. 

Within the body of the uterus is a flat cavity which is 
somewhat triangular in shape, with an opening at each of 
the three corners. The two upper openings lead into the 
tubes, which will be described in a moment, while a third 
opening leads down into the cervix, the lower end of the 
cervix, in turn, protruding into the vagina. The upper 
and lower ends of the cervix are drawn in as though with 
a draw string so that they are scarcely more than small 
round holes. These are called the internal os and the exter- 
nal os. Fig. 3 gives an idea of how the cavity of the uterus 
and the cervix would look from the front, with the tubes 
reaching out from the upper corners of the uterus, and the 
cervix opening into the vagina. The uterus is lined with 
a soft mucous lining something like the lining of one's 
mouth. Bear this in mind, for this lining represents, 
in part, the soil in which the tiny human seed is planted 
and through which its roots draw nourishment. 

The Fallopian tubes are two little muscular passage 
ways, about five inches long, which extend from the two 
upper corners of the uterine cavity toward the sides of the 
pelvis. The tubes are very small where they arise from 
the uterus, but gradually grow larger toward their free ends 
and finally spread out into wide, funnel-shaped openings 
that lead directly into the abdominal cavity. The tubes, 



WHERE THE BABY'S LIFE BEGINS 



25 



also, are lined with a mucous membrane but of a most 
surprising kind. Its surface is covered with tiny hair like 
projections which make it something like a brush with very 
soft, moist bristles. These little hairs are in constant mo- 




Nd.g\-noX ©uSWS 



Fig. 3. — Diagram showing the structure and relation of the female 
generative organs, as seen from the front. 

'ion, waving and sweeping along in much the same way 
that a field of wheat waves and sweeps in the wind. Re- 
member about this, too, for it has something to do with 
the very beginning of the baby. 

The Ovaries. Very near and a little below the flaring, 
open ends of the tubes are the ovaries, the sex glands of the 



26 



GETTING READY TO BE A MOTHER 



female. There is one on each side, held in place by liga- 
ments and they are about the size and shape of almonds. In 
the ovaries are embedded the ova, or eggs, the female germ 
cells which are concerned with producing the baby and 
also with the function of menstruation. 

Just a word about what is meant by ' ' a cell. ' ' It is sim- 
ply a tiny mass of jelly-like substance, called protoplasm, 



"nucleolus — 

or 
gerim spot 



nucleus 




protoplasm 



Fig. 4. — Diagram of human ovum. 



contained in a thin membrane or skin and is so small that it 
can be seen only through a microscope. In its unmatured 
state the ovum is a single cell, about 1/125 of an inch in 
diameter. In the protoplasm there is a spot called the 
nucleus and within this a smaller one called the nucleolus, 
or the germinal spot. These are long names and you need 
not remember them unless you want to, but glance at Fig. 
4 which shows an ovum and you will see that in its general 
structure it is much like a hen's egg, for the latter has a 



WHEKE THE BABY '8 LIFE BEGINS 27 

yolk within the white and on the yolk a tiny speck or 
germinal spot. The formation of each woman's full quota 
of ova, fifty thousand or more, is probably complete at the 
time of her birth. 

The vagina is a muscular tube, or passage way, leading 
from the outside of the body to the cervix, which you will 
remember is the lower part of the uterus. The vagina 
slopes upward from its opening and instead of meeting the 
cervix evenly it meets it almost at right angles and en- 
cases it like a sheath for about half an inch. Fig. 2 shows 
how these organs would appear if we were looking at them 
from the side. 

The Bladder. If you will glance again at Fig. 2, you will 
see that just in front of the vagina there is a tin-y passage 
leading up to a sac which also is in front of the vagina, and 
since in this picture it is practically empty, it lies below 
the uterus. This sac is the bladder and you can readily 
understand that as the uterus enlarges during pregnancy, 
it presses upon the bladder and this pressure on the outside 
gives the same sensation as is produced by pressure from 
the inside when the bladder is filled with urine. That is 
why the expectant mother has such a constant desire to 
urinate during the early Aveeks of pregnancy, before the 
uterus pushes up into the abdomen, and also during the 
later weeks, as well as during labor, when the bladder is 
being pressed upon by the baby's head. 

The Rectum. In the same picture you will see the rec- 
tum which lies just behind the uterus and vagina and which 
terminates in the anus. Between the rectum and the vagina 
is a thick triangular mass of muscle, called the perineum, 
which practically forms a floor to the pelvis, the bony basin 
without a bottom. 

The external genitalia, sometimes called the vulva, 
really have nothing to do with the creation of the baby, but 



28 GETTING READY TO BE A MOTHER 

you will better understand some of the care that is given 
you if you know a little about them, too. Between the 
thighs, where they join the body, are two thick folds of flesh, 
called the labia and between these lie the perineum, just 
mentioned, and the openings from the rectum, vagina and 
bladder as shown in Fig. 2. 

Now that we have something of an idea of the structure 
of the organs concerned with the creation of the baby, we 
shall want to learn about the usual activities of these in- 
teresting little parts, before the baby begins his life within 
them. 

Puberty or Adolescence. You know, of course, that girls 
are incapable of becoming mothers until after what is 
termed puberty, or adolescence, and by these terms we 
mean the period during which childhood develops into 
sexual maturity, and the individual becomes capable of re- 
production. The age at which puberty occurs varies with 
climate, race and occupation and with different individ- 
uals of the same status. But the average for girls, in tem- 
perate climates, is from the twelfth to the sixteenth year 
and for boys from the fourteenth to the seventeenth year. 
Girls in southern climates sometimes mature as early as the 
eighth or ninth year while in colder regions puberty 
may be delayed until they are eighteen or twenty years 
old. 

The occurrence of puberty marks the establishment of 
ovulation and menstruation, two functions which are usu- 
ally performed once a month during the childbearing 
period. 

Ovulation, which probably occurs about midway between 
the menstrual periods, is simply the name which has been 
given to the principal function of the ovary and may be 
defined as the development of the ovum, or egg, and its ex- 
pulsion, when mature, from the ovary. As the entire hu- 



WHERE THE BABY'S LIFE BEGINS 29 

man body has its origin in this tiny ovum, its career and 
course of development are of momentous importance to 
us, and at the same time furnish a tale of absorbing in- 
terest. The ovaries are packed full of these tiny egg-like 
cells, which probably lie dormant, as stated before, until 
the girl reaches puberty. Then they begin to develop and 
grow and push their way from the inside of the ovary to 
the surface where they look more or less like blisters. When 
an ovum reaches the surface of the ovary, a thin membrane 
which contains it, bursts, and it is suddenly expelled into 
the abdominal cavity. You will remember that the ovary is 
very near the funnel-like end of the tube, so. when the little 
cell is shot out of the ovary, it finds itself floating around 
quite close to this wide opening. Some of the ova that are 
projected into the abdominal cavity are doubtless lost, but 
others find their way into the near-by mouth of the tube, 
and if not fertilized by uniting with a male cell, which we 
shall explain presently, they pass down the tube into the 
uterus and are finally carried out in the menstrual flow. It 
is probable that as a rule only one ovum ripens and es- 
capes from the ovary each month from puberty until the 
menopause or change of life. 

The interesting thing about all of this is that each time 
an ovum does mature and is discharged from the ovary, 
the lining of the uterus becomes thicker and softer in order 
to facilitate the attachment of the ovum, if it is fertilized, 
this attachment being necessary if a baby is to develop. 
This preparation of the uterine lining is often, and very 
appropriately, referred to as " nest -building. " 

Menstruation, which is the evidence of sexual maturity, 
is a monthly hemorrhage from the uterus, escaping through 
the vagina, and it normally recurs regularly throughout the 
child-bearing period, except during pregnancy and while 
the vouno; mother nurses her babv. The length of this child- 



30 GETTING READY TO BE A MOTHER 

bearing period is about thirty years and continues from 
puberty until the menopause. The frequency of the men- 
strual periods varies from twenty-one to thirty days but 
the normal interval between periods is twenty-eight days, 
which is the length of what is called the ' ' menstrual cycle. ' ' 
Thus it is usually a lunar month from the beginning of one 
period to the next one, making thirteen menstrual periods 
during each calendar year. The complete course of a men- 
strual cycle consists of four stages, which, it is believed, 
occur somewhat as follows : 

The first, or constructive stage, lasts about seven days. 
It is during this stage that the preparations are made to 
receive the ovum traveling down the tube. The entire 
uterus becomes congested with blood and is somewhat en- 
larged and softened as a result, while its lining grows red, 
thick and velvety. If the ovum remains unfertilized, which 
is usually the case, it does not attach itself to this elabo- 
rately prepared lining, but passes out with the uterine dis- 
charges and all of this preparation not only goes for 
naught but must be undone. 

The second stage, therefore, which lasts about five days, 
is the destructive stage and is the period we speak of as 
menstruation. During this period the extra tissue 
which has been formed in the uterus is broken down; it 
mixes with the blood that oozes from the congested lining 
and together they pour from the vagina as the menstrual 
flow. 

The third or reparative stage, which follows, occupies 
about three days during which time the uterus and its lin- 
ing return to their normal state. 

The fourth, or quiescent stage, now follows and lasts 
twelve or fourteen days. This is the time remaining before 
Nature, with unwearying patience, begins all over again to 
prepare for the reception and attachment of the next ma- 



WHERE THE BABY'S LIFE BEGINS 31 

tured ovum, in case of its possible fertilization. And so 
it goes, month after month and year after year. 

It is very important for a woman who is suffering from 
painful menstruation to consult a doctor about correcting 
the cause, in the interests of her future child-bearing, if 
for no other reason, for this is one step toward preparing 
a good soil in which to plant the seed from which a baby 
may grow. For example, a misplacement of the uterus i 
a frequent cause of painful menstruation and if it re- 
mains uncorrected may make conception impossible; or if 
conception perchance does take place, the malposition of 
the uterus may, later, be the cause of an abortion or mis- 
carriage. Inflammation of the lining of the uterus is an- 
other cause of menstrual difficulty and if allowed to persist, 
may interfere later on with the normal development and 
nourishment of the baby. 

The menopause, also termed the climacteric, or the 
change of life, marks the permanent stopping of menstrua- 
tion and ability to bear children. This ordinarily occurs 
between the ages of forty and fifty, the majority of women 
ceasing to menstruate during their forty-sixth year. 

The most favorable age for motherhood to begin is a sub- 
ject of considerable interest to most women. When it is 
considered from all standpoints, social, ethical, spiritual as 
well as physical, the most favorable age for motherhood 
to begin seems to be sometime in the early twenties. Chil- 
dren have been born to little girls nine years old and to 
women over sixty, but the extremes of the reproductive 
years are not favorable periods for child-bearing. 

Now a word about the breasts. They appear to be 
merely large, soft masses of fat, one on each side of the 
chest, having no connection with the pelvic organs. But in 
reality they are very complicated glands and strangely 
enough, though no one knows why, their activities are con- 



32 



GETTING READY TO BE A MOTHER 



trolled by the activities of the generative organs down 
in the pelvis. Certain it is that their function is very im- 
portant to the baby, for the breasts are the factories in 
which nourishment is produced to nourish him during the 
first few months after he is born. 

If we could look inside of the breasts we should see that 
in structure they are much like several clusters of grapes 







■ 



FIG. 5. — Front view of breast, showing areola; openings from milk 
ducts and the glands beneath the skin. 



in which the stems and grapes are hollow. The milk is 
formed in the tiny sacs corresponding to the grapes, and 
pours into the little tubes conforming to the stems; these 
empty into a central tube, opening upon the surface of the 
nipple from which the baby will extract his nourishment. 
If you will look at Fig. 5 you will see in that picture of the 
front of a breast, that a part of it apparently has been 
magnified to show these openings of the milk ducts. There 



WHERE THE BABY'S LIFE BEGINS 33 

are about fifteen or twenty of them in each nipple. The 
picture shows also the little glands which appear as small 
lumps under the skin around the nipple, both in the dark 
circle called the areola and in the white skin surround- 
ing it. 

Summing up this chapter briefly, we find that the pelvis 
is an irregular, bony canal or basin, drawn in about the 
middle, thus forming the upper, or false pelvis and lower 
or true pelvis, neither of which has a bottom. The open- 
ing between these two basins is called the inlet, while the 
lower margin of the true pelvis is called the outlet, but 
it is the inlet that is of particular importance during 
child-birth. In the center of the lower pelvis and swung 
upon ligaments attached to its sides is the uterus, whose 
lower part, called the cervix, extends downward into the 
vagina; while reaching out from the upper corners of the 
uterus are the tubes, and near their open ends, one on each 
side, are the ovaries filled with germ cells called ova. The 
bladder lies in front of the uterus and vagina and the rec- 
tum behind, while below is the perineum, forming a floor to 
the pelvic cavity. Every four weeks during the child- 
bearing years an ovum is expelled from one of the ovaries 
into the abdominal cavity and the uterus regularly pre- 
pares to receive it in case of its fertilization, but if it is 
not fertilized the ovum is lost and menstruation occurs. 

"We see, too, that although the breasts are situated re- 
motely from the pelvic organs they are really very im- 
portant accessories, since they provide milk to nourish the 
baby after his life within the uterus is terminated by his 
birth. 



CHAPTER IV 
HOW THE BABY DEVELOPS BEFORE HE IS BORN 

Now that we know something of the place where the 
baby's life begins and how the way is prepared for his 
growth, we are ready to follow the interesting course of 
events that occur from the time the seed, a tiny egg-like 
cell, bursts from an ovary until the beautiful, fully de- 
veloped baby comes into the world. 

You will remember that when the ovum is expelled from 
an ovary it may float about in the abdominal cavity and be 
lost or it may enter the near-by mouth of a tube. Also 
that if it enters a tube it is carried downward toward 
the uterine cavity by the sweeping motion of the hair-like 
projections on the lining of the tube. This journey of the 
ovum through the tube is of enormous consequence, for dur- 
ing its course occur the events which decide whether the 
ovum shall, like most of its fellows, be simply swept along 
to no end and lost, or whether by chance it is to receive 
the mysterious impulse which begins the development of a 
new human being. The amazing power which enables this 
cell to reproduce itself, and to develop with unbelievable 
complexity is acquired somewhere in the tube, usually in 
the upper end, by meeting and fusing with a sperma- 
tozoon, the germinal cell of the male. 

The spermatozoa are attracted to the ovum much as 
bits of metal are drawn to a magnet, but although the 
ovum that is destined to be fertilized is surrounded by 
several spermatozoa, only one actually enters and fuses 
with it. 

34 



HOW BABY DEVELOPS BEFORE BIRTH 35 

This fusion is termed fertilization, or, in lay parlance, 
conception, and the instant at which it occurs marks the 
beginning of pregnancy. The establishment of this fact 
is of considerable importance, since it does away with 
any possible controversy concerning the time at which a 
new life begins. The origin of the baby is exactly coinci- 
dent with the fusion of the male and female cells. Fur- 
thermore, the sex of the child and any inherited traits and 
characteristics are also established at this decisive moment. 
No amount of dieting, exercise or mental effort on the part 
of the expectant mother can alter or influence them in the 
smallest degree, for the father has made his complete contri- 
bution toward the creation of the new being and the 
mother, also, has made hers, except for nourishment which 
she provides throughout pregnancy. 

All told, probably more than five hundred theories have 
been advanced to explain what it is that decides of which 
sex the forthcoming child is going to be. But as the results 
of applying these theories have scarcely borne out the 
claims of their advocates, they are given but scant attention 
to-day. 

The present belief regarding the causation of sex is that 
although there is but one kind of ovum, there are two 
kinds of spermatozoa, one capable of producing a male 
and the other a female child, but the sex-determining form 
of the male cell that fertilizes any one ovum is a matter 
of the merest chance. Statistics show that more male than 
female babies are born, the usual proportion being about 
105 boys to 100 girls among those who are carried to 
"term" or the end of pregnancy. Among abortions and 
prematurely born babies there is also a larger number of 
boys than girls, but as more boys than girls die in infancy, 
the two sexes about even up in the number of those living 
to adult life. 



36 



GETTING READY TO BE A MOTHER 



Concerning the time of the month when conception is 
most likely to occur, there is a wide difference of opinion. 
Some doctors think that the most favorable period is just 
before or just after menstruation, while others believe that 
conception is most likely to take place about midway be- 
tween the menstrual periods. 

Returning to the ovum which meets a spermatozoon in 
the course of its journey down the tube, we find that as 




i-nternal 

mass 



Late v sta tf e& of c e\\ <3l »y \ s \ o n . 

Fig. 6. — Diagram indicating process of cell division. 

soon as a spermatozoon enters an ovum it disappears and is 
completely absorbed, and, as the ovum in turn is instantly 
possessed of new powers, through the presence of the male 
cell, the result of this union is an entirely new cell. But 
instead of continuing its existence as a single cell, the fertil- 
ized ovum divides into two cells ; these two into four ; the 
four into eight and so on until a clustering mass of cells is 
formed which looks something like a mulberry. If you will 
look at Fig. 6 you will see what happens as this cell division 
progresses and also that in time the cells rearrange them- 
selves in such a way as to leave a space in the center of the 



HOW BABY DEVELOPS BEFORE BIRTH 37 

mass so that it becomes a little sac with a cluster of cells at 
one point, which hangs toward the center, called the intt rnal 
cell mass. This will interest you because it is from cells at 
one point in this little cluster that the baby begins to de- 
velop, together with the cord, bag of waters and after- 
birth, to be described later. 

While these changes are taking place, the entire mass is 
being carried slowly down the tube toward the uterus by 
the sweeping motion of the soft little hairs on the lining 
of the tube. It is steadily growing, and by the time it 
reaches the uterus the mass is about the size of the head 
of a pin. As you will remember, the lining of the uterus 
prepares each month to receive the fertilized ovum, becom- 
ing soft and thick. The cell mass floats around for a little 
while after it reaches the uterine cavity and then resting at 
some point, sinks down into the soft lining and is completely 
buried. 

From now on the cells which compose the mass rapidly 
increase in number and very shortly cease to be all of one 
kind. These different kinds of cells rearrange themselves 
and grow in such a manner that some of them begin to 
form the different parts of the baby's body and others 
develop into two thin membranes that finally enclose the 
baby in a double sac. He is attached to the inner surface 
of the sac ; the space which he does not occupy is filled with 
fluid and the sac itself is attached to the uterine lining at 
the point where the cell mass happened to stop and bury 
itself. 

This sac is what you have heard called the "bag of 
waters," but the doctors refer to it as the membranes. 
As it enlarges and pushes out into the uterine cavity it still 
consists of two thin membranes except where it is attached 
to the uterus, at which point it grows into a thick, spongy 
mass of blood-vessels. These blood-vessels divide and 



38 



GETTING READY TO BE A MOTHER 



branch out in a tree-like fashion and burrow into the 
uterine wall. As you will see later, it is through this mass 
of branching blood-vessels that the baby virtually eats and 
breathes and gives off waste materials during the nine 
months of his life within the uterus. The doctors refer to 



Tuta^iS 




Uter i-ne caVi^M 

OJterutte vuall 
-Inter nail os 

-Cervix 

erna.1 6s 

FlG. 7. — Diagram showing the developing baby, at an early stage, with 
cord, membranes and placenta, within the uterine cavity. 



the mass as the placenta but you have heard it called the 
"afterbirth," because it is expelled after the baby is born. 
As the baby's development advances the part by which 
he is connected with the placenta lengthens out into what 
is called the umbilical cord. There are blood-vessels in 
this cord through which blood constantly flows back and 
forth, carrying nourishment to the baby from his mother 



HOW 13A13Y DEVELOPS BEFORE BIRTH 39 

and waste matter from his Little body to the placenta where 
it is taken up by her blood. But this exchange of materials 
takes place through thin membranes and consequently the 
blood of the mother and baby never mingle. Fig. 7 will 
give you an idea of how the sac of membranes, with the baby 
hanging inside, grows out into the uterine cavity; how at 
the point where the membranes are attached to the uterus 
the blood-vesscU have developed into the thick, spongy 
placenta and how the baby is connected with it by means 
of the cord. In Fig. s yon may sec how the baity changes 
in appearance as the weeks of pregnancy go by. At the end 
of the fourth month he really looks quite like the baby that 
we are so eagerly preparing for. 

If we follow his development within the uterus month 
by month, we find that by the end of the first lunar month, 
or fourth week, the baby's body is about y 2 inch long and 
looks about as is suggested in the third little outline in 
Fig. 8. 

At the end of the second month, or eighth week, his 
head is fairly well shaped: bones are beginning to develop, 
webbed hands and feet are formed and the little body is 
about 1 inch long. 

At the end of the third month, or twelfth week, his 
entire body shows marked development and is about 3 1 * 
inches long. His lingers and toes are separated and bear 
soft nails: the teeth are forming, the eyes have lids and the 
umbilical cord has taken definite form. 

At the end of the fourth month, or sixteenth week, in 
addition to the development of all parts a fine, soft hair 
appears over the body: there is a black, tarry substance, 
called meconium, in the baby's intestines and he measures 
about 6 inches in length and weighs perhaps a 4 pound. 

By the end of the fifth month, or twentieth week, the 
baby lias grown and developed markedly. He is now cov- 



40 GETTING READY TO BE A MOTHER 




* I 






C 
d 



HOW BABY DEVELOPS BEFORE BIRTH 41 

ered with skin on which are occasional patches of a greasy, 
cheesy substance called verrrix caseosa, and though there is 
some fat beneath the skin his face looks old and wrinkled. 
A certain amount of hair has appeared upon the head and 
the eyelids are opening. It is usually during the fifth 
month that the expectant mother first feels her baby move, 
this sensation being commonly referred to as "quickening." 
He is now about 10 inches long and weighs about 9 ounces. 

By the end of the sixth month or twenty-fourth week, 
the baby is about 12 inches long and weighs possibly 1% 
pounds. He is thin and wrinkled in appearance and if born 
at this time will attempt to breathe and move his limbs but 
will perish in a short time. 

By the end of the seventh month, or twenty- eighth 
week, he still looks thin and scrawny ; his skin is reddish 
and is well covered with the cheesy vernix caseosa. If born 
at this stage, the baby will move quite vigorously and ery 
feebly, but he is not likely to live for any length of time. 
He is now about 14 inches long and weighs about 2% 
pounds. 

By the end of the eighth month, or thirty-second week, 
the baby has grown to about 17 inches in length and 4 
pounds in weight, but continues to look thin and old and 
wrinkled. His nails do not extend beyond the ends of his 
fingers but are firmer in texture ; the soft, downy hair begins 
to disappear from his face but the hair on his head is more 
abundant. If born at this stage, the baby will have a fair 
chance to live, provided he is given painstaking care. This 
is true in spite of the old belief, still widely current, that a 
seven months' baby is more likely to live than one born at 
eight months (meaning calendar months). The fact is that 
after the twenty-eighth week the probability of the baby's 
living increases greatly with each added week of life within 
the uterus. His growth during the latter part of pregnancy 



42 



GETTING READY TO BE A MOTHER 



is rapid, for he gains nine tenths of his weight after the fifth 
month and one half of his weight during the last eight 
weeks of uterine life. 

At the end of the ninth month, or thirty-sixth week, 
the increased amount of fat under the baby's skin has given 
a plumper, rounder contour to the entire body; the aged 



Uterine vua.\K^<~ 




Fig. 9. — The usual position of the baby just before he is born. 



look has passed and his chances for life have greatly in- 
creased. He weighs about 5% pounds at this stage and is 
perhaps 18 inches long. 

The end of the tenth month, or fortieth week, usually 
marks the end of pregnancy. Fig. 9 will show you how the 
baby lies in the uterus just before birth, curled up into the 
smallest possible space. 



HOW BABY DEVELOPS BEFORE BIRTH 43 

The average normally developed baby has grown to a 
length of about 20 inches and weighs about 7% pounds, 
boys usually being about three ounces heavier than girls, 
but there may be a variation of weight among entirely 
normal, healthy babies from a minimum of 5 pounds to as 
high as 11 pounds or more. Newborn babies very seldom 
weigh more than 12 pounds, in spite of legends and rumors 
to the contrary. 

The size of the baby is affected by the race of his parents ; 
colored babies, for example, averaging a smaller weight than 
white babies. And, as might be expected, the size of the 
parents is likely to be reflected in their infants, large par- 
ents tending to have large children and vice versa. 

The number of children which the mother has previously 
borne is also a factor, since the first child is usually the 
smallest, the size of those following showing an increase with 
the mother's age up to her twenty-eighth year, if her preg- 
nancies do not occur at too frequent intervals. 

Twins. Sometimes a woman gives birth to more than 
one baby at the same time. When there are two they are 
called twins; triplets when there are three; quadruplets, 
quintuplets and sextuplets respectively, when there are 
four, five and six babies within the uterus at once. Six 
is the largest accredited number on record. 

It is estimated that twins occur once in ninety preg- 
nancies and triplets once in about seven thousand cases. 
The tendency seems to be inherited, as is evidenced by the 
number of twins and triplets to be found among relatives. 

Twins are often prematurely born and each is likely to 
be smaller than a baby resulting from a single pregnancy, 
but their combined weight is greater than the weight of one 
normal baby. 

Extra-uterine Pregnancy. Another departure from the 
normal pregnancy is when the baby develops outside of the 



44 GETTING READY TO BE A MOTHER 

uterus. Although in the normal course of events the fer- 
tilized ovum travels down the tube and becomes attached 
to the uterine lining, it is possible for it to stop, and 
more or less completely develop at any point along the 
way. This is called an extra-uterine pregnancy, since it 
occurs outside of the uterus. If the baby develops in one 
of the ovaries, it is termed an ovarian pregnancy, and a 
tubal pregnancy if it develops in a tube, this being the most 
frequent variety of extra-uterine pregnancies. Only about 
one out of a hundred such pregnancies continue throughout 
the allotted period, and accordingly, a live baby, capable of 
living for any length of time, seldom results. 

To sum up a normal pregnancy, we find that in the course 
of ten lunar months following the fertilization of an ovum, 
the uterus grows from a small, flattened pelvic organ, 3 
inches in length, to a large muscular sac, about 15 inches 
long occupying the abdominal cavity. It increases its weight 
sixteen times, that is, from 2 ounces to 2 pounds, while 
the capacity of the uterine cavity is multiplied five hundred 
times. Within the uterus is a baby weighing about l 1 /^ 
pounds; a placenta weighing perhaps l 1 /^ pounds and ap- 
proximately a quart of fluid. The baby is attached to the 
placenta by means of a jelly-like cord about as thick as 
one's first finger and 20 inches long; baby, placenta, cord 
and fluid all being contained in a thin, but strong sac fre- 
quently called the bag of waters, but by the doctors termed 
the membranes. The total weight of the uterus and its 
contents at the end of pregnancy is usually about 15 
pounds. 

Throughout the baby's life within the uterus, the placenta 
virtually acts as his digestive organs, lungs, kidneys and 
bowels. Bear this in mind, and you will realize why, in 
taking care of yourself you are taking care of your baby 
while his body is being built and getting itself into running 



HOW BABY DEVELOPS BEFORE BIRTH 45 

order to take up life as a separate being. The full realiza- 
tion that whatever is good for yon is good for your baby 
will make you eager to give yourself the care that is out- 
lined in the next chapter. 



CHAPTER V 
TAKING CARE OF THE BABY BEFORE HE COMES 

We shall see that taking care of your baby before he 
is born means taking" such care of yourself throughout 
pregnancy, that you not only keep your own body in its 
usual good running order, but in addition, so effectively 
promote the activities of your various organs that you 
also keep the baby's body going, his body that is grow- 
ing all the time. 

Quite reasonably this requires extra work on the part 
of some of your organs, particularly those concerned with 
digestion and the process of throwing off impurities. The 
latter is of the greatest possible importance for in addition 
to excreting the usual amount of impurities from your own 
body you must excrete also those thrown off by your baby. 
The amount of waste from him is not large but it seems 
to be of such a character that it harms the mother if it is 
not steadily excreted. 

Good digestion and satisfactory excretion are dependent 
upon a number of factors and fortunately most of them 
are within your own control. 

Your frame of mind is one of the most important factors 
or* all. I know that to suggest the cultivation of a cheerful, 
hopeful mental attitude is easier said than done. But 
after all it really is largely a matter of habit which you 
can acquire if you set yourself to it, particularly if you 
realize that your physical condition will be benefited by 
your going through pregnancy happily. And remember 
that whatever is good for you is good for your baby. 

4G 



CARE OF THE BABY BEFORE HE COMES 47 

Continue with the work, amusements and exercise that 
you are used to and enjoy, except of course such activities 
as the doctor may forbid. In general, try to forget that 
you are pregnant, so far as you can do this and still re- 
member to take proper care of yourself. 

Above all, don't worry. Worry will interfere with your 
sleep and it will also upset your digestion quite as seri- 
ously as will wrong food. Try not to be too self-centered 
or too watchful of your symptoms, but at the same time 
avoid the dangerous habit of thinking that any unusual con- 
dition which develops is due to your being pregnant, for a 
sick pregnancy is not normal. 

It will relieve you of a great deal of anxiety if you report 
to your doctor everything you do not understand, for the 
consciousness that he will know just what to do, if anything 
is necessary, will help to keep you from worrying. 

It is important, too, for you to get rid of the depressing 
beliefs in connection with pregnancy that have come down 
to us through the ages. 

For instance, do not believe for a moment that anything 
you do, think or see can ''mark" or deform your baby, for 
remember that after conception you give him nothing but 
nourishment. The only communication between you and 
the baby is through your and his blood, and blood does not 
carry mental impressions. Accordingly, no effects of fear, 
horror or unpleasant memories which you may have can 
possibly reach him. It is true that once in a while a woman 
does see something shocking and later gives birth to a 
marked or deformed baby. But there is little doubt, 
now, that such an occurrence is merely a coincidence. If 
you will stop and think for a moment you will realize that 
most expectant mothers see or hear or think something 
unpleasant at some time during pregnancy, and yet most 
babies are born without mark or blemish. Anger, fright 



48 GETTING READY TO BE A MOTHER 

or sudden shock may upset your digestion, but it does not 
directly affect your baby. 

As for that common belief that in "reaching up" the 
mother may slip the cord around the baby's neck — if you 
will picture for a moment how the baby lies within the 
uterus you will realize how impossible this is, for the 
mother's arms have no connection with him or the cord. 

So dismiss these doubts and fears from your mind and 
dwell instead upon the loveliness of what is in store for 
you, for, I repeat, your physical condition will be bene- 
fited if you go through pregnancy happily. And remember 
again that whatever is good for you is good for your baby. 

So your first step toward caring for the little life already 
within your charge is to follow the example of Mrs. Wiggs, 
who constantly wiped the dust from her rose-colored spec- 
tacles. 

Now for the more specific details of your care. Of these 
the question of your diet is of enormous importance. 

Let us consider first what your food accomplishes if it 
is suitable and conditions are favorable for its use by you 
and the baby. It should provide nourishment for your 
various tissues, as under ordinary conditions; it should 
promote the activities of your skin and kidneys, as well 
as bowels, since it is through them that the waste from 
your own and your baby's body must be excreted, and your 
food should be adequate also, to build and nourish the 
baby's body without his having to draw materials from 
your tissues. Strange as it may seem, the baby's physical 
needs are supplied before yours are met, and if there 
are not enough food materials for you both, your bones, 
teeth and muscles will be deprived. Furthermore, taking 
proper food during pregnancy is an important step toward 
preparing yourself to nurse your baby, after he is born, 
which is quite as urgent as nourishing him before birth. 



CARE OF THE BABY BEFORE HE COMES 49 

To accomplish these ends you not only must eat suitable 
food, but you must digest and absorb it as well. This re- 
quires that you constantly guard against overeating, con- 
stipation and indigestion of any kind. Indigestion may be 
avoided during pregnancy exactly as it is at other times, 
by eating proper food, by cultivating a happy frame of 
mind; by having sufficient exercise, fresh air, rest and 
sleep. 

If you are accustomed to a fairly simple, well balanced, 
mixed diet, you probably will need to make little or no 
change, except to have the evening meal light if it has been a 
hearty one. II may surprise you to learn that you need 
not "eat for two," in quantity, as is so commonly believed 
necessary, for during pregnancy you make so much better 
use of food materials than usual that an amount and kind 
of food that keep you in good condition will be adequate to 
meet 3 T our baby's needs, too, until the latter part of preg- 
nancy. On the other hand, it is very unwise for an expect- 
ant mother to cut down her diet, with the idea of keeping 
the baby small and thus make labor easy, except under 
the direction of her doctor. In general it is the size of the 
baby's head that makes labor easy or difficult, and not the 
amount of fat distributed over his body. And if the mother 
cuts down the minerals in her diet to make the baby bones 
soft, the only result is that her own bones and teeth are 
softened, because the baby extracts from them enough lime 
to supply what the food lacks. 

Three meals a day will usually be enough during at least 
the first half of pregnancy and they should be taken with 
clock-like regularity, eaten slowly and masticated thor- 
oughly. The possible need for slight additional food during 
the later weeks may be supplied more satisfactorily by 
lunches of milk, cocoa or broth and crackers or toast, be- 
tween meals and upon retiring, than by taking larger meals, 



50 GETTING READY TO BE A MOTHER 

An expectant mother who has a tendency to nausea early 
in pregnancy often feels better for taking a small lunch 
regularly five or six times daily instead of the usual three 
full meals. 

It is of the greatest importance that every pregnant wom- 
an drink an abundance of fluid to act as a solvent for her 
food and waste material and promote the activity of her 
kidneys, skin and bowels. She needs about three quarts 
daily, most of which should be water, the remainder consist- 
ing of milk, cocoa, soup and other liquids. Alcohol should 
not be taken except upon the doctor's orders and only 
moderate amounts of coffee and tea, unless he gives per- 
mission for more. 

The expectant mother will be wise to avoid fried food, 
pastry, rich desserts, rich salad dressings and any other food 
which would ordinarily disagree with her. 

Since the enjoyment of one's meals promotes digestion 
at all times, the expectant mother should try to eat the 
things that she enjoys most and that agree with her. The 
average pregnant woman who has no symptoms of com- 
plications will usually be able to supply her own and her 
baby's needs and at the same time keep within the bounds 
of safety if she selects her diet from the foods included 
in the following groups : 

Animal Foods. Milk and eggs are the most satisfactory, 
but for the sake of variety and to tempt her appetite the 
expectant mother will usually be allowed to take rather 
sparingly, and preferably only once a day, of fish, the 
various kinds of shell fish, beef, lamb, chicken or game. 
Pork, veal and goose should be avoided as a rule, and par- 
ticularly by women with whom they ordinarily disagree. 

Soups. Thin soups and broths have little food value but 
because of their appetizing flavor and aroma are an aid 
to digestion, and frequently by stimulating a flagging appe- 



CARE OF THE BABY BEFORE HE COMES 51 

tite will help the expectant mother to eat and assimilate 
more than she would without them. But cream soups and 
purees, have a high food value and, like thin soups and 
broths, also supply a definite amount of fluid which she 
must have. 

Vegetables. The group of vegetables generally desig- 
nated as "leafy" are of even greater importance to the 
expectant mother than they arc to the average person. Of 
these she may safely eat onions, asparagus, celery, string 
beans, spinach, and she should make a point of taking a 
green salad, such as lettuce, cress or romaine, at least once 
daily. Sweet potatoes, white potatoes, rice, peas, Lima 
beans, tomatoes, beets and carrots, also, may be eaten with 
safety, as a rule, but cabbage, cauliflower, corn, egg-plant, 
Brussels sprouts, parsnips, cucumbers and radishes should 
be taken with great caution and avoided altogether if they 
cause gas or any kind of distress. 

Fresh Fruits. A necessary part of the diet is fresh fruit, 
and among those fruits which are both beneficial and usu- 
ally harmless are apples, peaches, apricots, pears, oranges, 
figs, cherries, pineapple, grapes, plums, strawberries, rasp- 
berries, blackberries and grapefruit. These are more likely 
to be laxative if eaten alone, as before breakfast and at bed- 
time. Cooked fruits are also valuable articles of diet, but 
are probably less laxative than raw fruit. Some of the 
citrous fruits, oranges, grapefruit or lemons, should be 
taken daily because they possess a certain indispensable 
food value which is peculiar to them. 

Cereals. For their nourishing and laxative qualities, 
cereals are important and their food value is increased by 
the milk and cream which are usually taken with them. 
Cooked cereals should invariably be cooked longer than the 
usual directions suggest. Bran, eaten alone as a cereal or 
in combination with other grains, is an excellent laxative. 



52 GETTING READY TO BE A MOTHER 

Breads. Graham, cornineal, whole wheat and bran bread 
are all good. In general the expectant mother will be on 
the safe side if she eats sparingly, if at all, of very fresh 
or hot breads and hot cakes. 

Desserts. Desserts are very important for they add to 
the attractiveness of most people's meals, and if wisely 
chosen and properly made, may supply a good deal of easily 
digested nourishment. They may include, in addition to 
fresh and cooked fruits and preserves, ice-cream, a wide 
variety of custards, creams and puddings made largely of 
milk, eggs and some ingredient to give substance and firm- 
ness, such as gelatin, cornstarch, rice, tapioca, farina, ar- 
row-root and similar materials. 

In general the expectant mother should eat an abundance 
of fruit and vegetables, taking at least some uncooked fruit 
and a green salad, daily, and make sure that her food con- 
tains a good deal of residue, such as is provided by fruit 
and coarse vegetables. This residue increases the bulk of 
the material in the intestines, and this helps to overcome the 
tendency toward constipation. As fat is less easily digested 
than starchy foods, and more likely to cause nausea during 
pregnancy, it is better to eat no more fat than usual but to 
supply the additional material which is needed after about 
the sixth month, by taking a little more starchy food. How- 
ever, a slight increase only is necessary, and this chiefly 
during the last three or four weeks. 

The Kidneys. It is scarcely possible to say enough about 
the importance of keeping your kidneys in normal working 
order during pregnancy, for through them is excreted much 
of the waste matter from your baby's body as well as 
your own. Sometimes when these impurities are not 
thrown off as they should be the expectant mother has con- 
vulsions. You will be glad to know how much you yourself 
can do toward preventing convulsions by drinking plenty 



CARE OF THE BABY BEFORE HE COMES 53 

of water and by faithfully measuring your urine and taking 
a specimen to the doctor when he asks you to. As I said 
before, you should drink at least three quarts of fluid every 
day. Most of this should be water, the remainder being 
milk, cocoa, soup, tea, coffee, and so on. 

The doctor will probably want you to measure your 
urine and take a specimen to him once a month during the 
first half of pregnancy and every two weeks afterward, or 
even every week toward the end. He can tell by examining 
the urine whether your kidneys are acting as they should 
and if they are not he may save you serious trouble by put- 
ting you to bed for a few days with no nourishment but 
milk and water. 

In preparing a specimen you will need a covered corked 
vessel large enough to hold all the urine passed in twenty- 
four hours, and it must be thoroughly washed and scalded. 
The next step is to pass urine, suppose we say at eight 
o'clock in the morning, and throw it away. All of the urine 
which you pass after this time until eight o'clock the next 
morning must be saved in the vessel and kept in a cool 
place to prevent its decomposing. If you will put a tea- 
spoonful of chloroform or boracic acid powder into the ves- 
sel it will tend to preserve the urine and will not injure 
the specimen. At the end of twenty-four hours the urine 
should be shaken to mix it thoroughly and about half a 
pint poured into a bottle that has been washed and scalded. 
Carefully cork and label this with the date, your name 
and address and the total amount of urine passed in the 
twenty-four hours. The vessel for collecting the urine and 
whatever you use as a measure should be reserved for these 
purposes only. If you have no tin or glass measure, a 
regular-size quart tomato can will prove entirely satisfac- 
tory. 

If you find, when measuring your urine, that you pass 



54 GETTING READY TO BE A MOTHER 

less than a quart and a half in twenty-four hours, you may 
know without being told that this is not enough and that 
you should drink more water. 

The Skin. People are likely to think of the skin as being 
simply a covering for the body, whereas, in reality, it is a 
very complicated and active organ which helps to regulate 
the body temperature and constantly throws off impurities, 
just as the kidneys do. This latter function is performed 
by the sweat glands which open upon the surface of the 
skin as the "pores," and we are told that in all there are 
some twenty-eight miles of these tiny tube-like structures 
in the skin. These glands should be, and usually are, con- 
stantly active ; they pour upon the surface of the body an 
oily substance which keeps the skin soft; they also excrete 
something more than a pint of water daily, which contains 
impurities that are harmful if retained in the body. We 
are not aware of this constant excretion of fluids, which 
is termed "insensible perspiration," but it continues even 
in cold weather and must not be stopped if health is to be 
preserved. If the oil, dust, particles of dead skin and the 
waste material left by dried perspiration are allowed to 
remain upon the surface of the body they will clog the 
pores, or gland openings, and thus interfere with their ac- 
tion. The removal of this material, then, is necessary to 
maintain health, and is done automatically in part for 
the fluid evaporates and much of the solid matter is rubbed 
off on the clothing. The most important aids to the 
skin's activity are the drinking of plenty of water, deep 
breathing, exercise and warm baths. 

Regular and thorough bathing serves the double purpose 
of removing waste matter already on the surface, and of 
stimulating the glands to increased activity in giving off 
still more. 

Many doctors advise a warm, not hot, shower or tub bath 



CARE OF THE BABY BEFORE HE COMES 55 

every day, with soap used freely over the entire body, fol- 
lowed by a brisk rub. The best time for this warm, cleans- 
ing bath, as a rule, is just before retiring, as it is soothing 
and restful, and tends to induce sleep. Very hot baths are 
fatiguing, particularly during pregnancy, and should never 
be taken except with the doctor's permission; but cold 
baths usually may be continued throughout pregnancy if 
one is accustomed to them and reacts w<-ll afterwards. Un- 
der these conditions the morning cold plunge, shower or 
sponge is beneficial, as it stimulates the circulation and 
thus promotes the activity of the skin. Some doctors for- 
bid tub bathing of any kind after the seventh month, on the 
ground that as the expectant mother sits in the tub her va- 
gina is filled with unsterile water and should labor occur 
shortly afterward an infection, or fever, might result. And 
as she is heavy and somewhat uncertain on her feet, there 
is also the danger of her slipping and falling while getting 
in or out of the tub. Other doctors permit tub baths 
throughout pregnancy, up until the onset of labor ; while 
as to hot foot baths, since there seems to be no reason for 
or against them at any time during the nine months, they 
may be taken or not at will. 

Bathing in a quiet stream or lake is apparently harmless 
but sea bathing, if the surf is rough, is inadvisable because 
of the beating of the waves upon the abdomen and the gen- 
eral violence of the exercise. 

The importance of keeping the body evenly warm 
throughout pregnancy cannot be overemphasized, for a sud- 
den chilling or wetting may so check action of the skin as 
to impose more of a burden upon the kidneys than they 
can meet, in their effort to throw off the skin's share of the 
body waste. Accordingly, a single chilling will sometimes 
be enough to cause convulsions. This may be one reason 
why convulsions occur more frequently during cold weather 



56 GETTING READY TO BE A MOTHER 

or after a sudden drop in the temperature after warm or 
mild days. 

The Bowels. The bowels, also, throw off a certain 
amount of impurities and if they do not move thoroughly 
at least once a day these impurities may be taken into the 
system and again the kidneys be given extra work. 

Unhappily a great many pregnant women are consti- 
pated, particularly during the later weeks, while women 
who have always had a tendency of this kind may have 
trouble with their bowels from the very beginning of preg- 
nancy. Your bowels should move regularly every day, 
and to this end you should attempt to empty them at the 
same hour each day, immediately after breakfast being the 
best time. The importance of regularity in making the 
attempt cannot be overemphasized, even though the bowels 
do not always move. 

The measures which tend to prevent constipation, as al- 
ready pointed out, are drinking plenty of fluids, and eating 
fresh fruit, coarse vegetables and bulky cereals such as 
bran; also taking a glass of hot or cold water just before 
going to bed and the first thing in the morning. You should 
not take enemas or cathartics without your doctor's order, 
but you may safely increase the amount of fluids which 
you drink and the bulk of your food, in order to regulate 
your bowels. 

Senna and prunes cooked together prove to be helpful 
in keeping the bowels regular and they are entirely harm- 
less. A simple way of preparing them for this purpose 
is to pour a quart of boiling water over an ounce of senna 
leaves and allow them to stand for about two hours. A 
pound of well washed prunes should soak overnight in this 
liquor, after it has been strained, and then cooked in it until 
tender. They may be sweetened with two tablespoonfuls 
of brown sugar, and the flavor improved by adding a stick 



CARE OF THE BABY BEFORE HE COMES 57 

of cinnamon or slice of lemon while they are cooking. Half 
a dozen of these prunes, with some of the syrup, may be 
taken at the evening meal to start with, and increased or 
decreased in number as necessary. 

Clothes. The chief purpose of clothes under all condi- 
tions is to aid in keeping the body warm, thus helping to 
preserve an even circulation of the blood and the activity of 
the sweat glands. As has been pointed out, this, is of espe- 
cial importance during pregnancy. The expectant mother's 
clothes should be not only sufficiently warm, but they should 
be equally warm over her entire body. They should be light 
and porous, and fairly loose, so as not to interfere with the 
circulation or other bodily functions. There must be no 
pressure on chest or abdomen; no tight garters, bolts, collars 
or shoes. 

The clothes of the mother-to-be. like every other detail 
of her care, must be adapted to her surroundings and mode 
of living. If her house is well and evenly heated during 
the cold months, she may quite safely dress lightly while in- 
doors; if it is not, she should wear underwear with high 
neck, long sleeves and drawers, both indoors and out, except 
when the weather is warm enough to cause perspiration. 
At all times, however, the warmth of her clothing should 
be suited to the temperature of the home, the climate and 
the state of the weather. 

Remembering that it is important for you to keep up 
the diversions and amusements that you enjoy, it is worth 
while to have your clothes as pretty and becoming as pos- 
sible, for you are much more likely to go about and mingle 
with your friends if you feel that you are becomingly and 
well dressed. At the same time your clothes should be so 
made that their weight will hang from the shoulders instead 
of from the waistband. 

And that brings us to the question of corsets, a much 



58 GETTING READY TO BE A MOTHER 

discussed garment. Women who have not been accustomed 
to wearing corsets will scarcely feel the need of adopting 
them during pregnancy except, perhaps, during the later 
weeks when the heavy abdomen needs to be supported for 
the sake of comfort. This need is felt particularly by 
women who have had children and whose abdominal walls 
are somewhat weakened in consequence. 

If you have been wearing comfortable, well fitting cor- 
sets, you probably will not feel the need of making a change 
until the third or fourth month. But by this time the baby 
will have pushed up out of the lower pelvis into the abdo- 
men and your corsets then, if you wear any, must be so 
constructed that they will not compress nor disguise your 
figure, but will provide support and accommodate them- 
selves to an abdomen that is steadily increasing in size and 
changing in shape. Such corsets are made of soft material ; 
have elastic inserts and have lacings at the sides as well as 
in the back. They come well down and fit snugly over the 
hips. (See Fig. 10.) Some women find comfort in attach- 
ing shoulder straps to their corsets thus suspending some of 
the abdominal weight from the shoulders. But as a rule, 
the most comfortable arrangement is a short-waisted mater- 
nity corset worn with a brassiere that supports the breasts 
and does not compress the nipples. 

I hope this description will make clear to you why the 
same style corsets as you ordinarily wear cannot be satis- 
factory during pregnancy, no matter how large they are, 
and may even prove harmful. 

Even a properly fitting maternity corset may become 
uncomfortable during the last few weeks of pregnancy, 
and have to be replaced by an abdominal supporter of 
linen or rubber. And when this stage is reached, even 
the woman who has worn no corsets may find that she is 
more comfortable if she adopts such a support, par- 



CAKE OF THE BABY BEFORE HE COMES M 

expected baby, because of their effect upon your entire well- 
being. 

The average individual uses up in a minute's time the 
oxygen contained in four bushels of air, and since the preg- 
nant woman takes in through her lungs the oxygen for 
both herself and her baby, she must have a sufficient quan- 
tity of air to supply at least this amount. 

Accordingly, you should make a point of spending at 
least two hours of each day in the open air. If the weather 
is so stormy or severe as to make it undesirable for you to 
go out from under cover, because of the danger of getting 
wet or chilled, you can wrap up well and take your airing 
on a protected porch or in a room with all the windows 
wide open. 

But this is only a part of it, for the air in your house or 
rooms must be kept fresh all day by being constantly 
changed ; this requires a steady inpouring of fresh air and 
outpouring of stale air. 

A very good way to accomplish this is to have one or more 
windows open slightly, top and bottom, all the time. But 
there must be no sudden changes of temperature, nor drafts, 
for fear of chilling your skin. At night you should sleep 
in a room with the windows open, taking care to be well 
protected by light, warm coverings. 

Exercise. Each detail of the expectant mother's daily 
routine seems to be more important than the last. And so 
when we come to the question of regular out-of-door exercise 
we are almost persuaded to believe that whatever else may 
be neglected, this is indispensable, since it promotes diges- 
tion, stimulates the activity of the skin and lungs, steadies 
the nerves, quiets the mind and promotes sleep. And more 
than that, walking, which is probably the most satisfactory 
form of exercise for her to take, also strengthens some of 
the muscles that are used during labor. But exercise is 



64 GETTING READY TO BE A MOTHER 

downright injurious if continued to the point of fatigue, 
no matter how little has been taken. Each woman must 
be a law unto herself in this matter, therefore, and must be 
impressed with the importance of stopping before she is 
tired. It may be a good plan for you to start by walking 
only a short distance at a time, increasing this gradually 
until you are able to walk possibly as much as an hour in 
the morning and an hour in the afternoon without fatigue. 

All violent exercise and sports are of course to be avoided, 
particularly swimming, horseback riding and tennis. While 
motoring and carriage driving are pleasant diversions, they 
cannot be classed as exercise. They should be taken only in 
comfortable vehicles and over smooth roads, so that there 
will be no jarring nor jolting, and the expectant mother 
should not do the driving herself. 

A certain amount of exercise, in the shape of light house- 
work, may be taken indoors. This is distinctly beneficial 
if not continued to the point of fatigue, both because of the 
exercise which it provides, and also the diversion and 
interest, for these promote mental and physical health. But 
this indoor exercise must not interfere with, nor to any 
degree replace the daily exercise which you take out of 
doors; nor must it include heavy work, such as washing, 
sweeping, heavy lifting, running a sewing machine by foot 
or much running up and down stairs. 

However, the amount and kind of work which the ex- 
pectant mother may comfortably and safely do, are so 
related to what she has been accustomed to, that it is not 
possible to do more than describe what has proved of benefit 
for the average woman. 

There are women to whom massage and gymnastics are 
helpful during pregnancy when for some reason the out-of- 
door activities are not possible or advisable. This might 
be true of an expectant mother with heart trouble, for ex- 



CARE OF THE BABY BEFORE HE. COMES 65 

ample, or of one who is being kept in bed to prevent an 
abortion and accordingly is a matter which is closely di- 
rected by the doctor. 

Traveling. In general, traveling is less dangerous for 
the expectant mother of to-day than formerly because it 
causes less strain, discomfort and fatigue than in the old 
days. But the question cannot be settled once for all women 
nor for all stages of pregnancy. Each woman's general 
condition must be considered; her tendency to nausea; the 
length of the journey and the ease with which it may be 
made ; also, whether or not she has ever had or been threat- 
ened with an abortion. As a rule, it is considered wise to 
avoid traveling during the first sixteen and the last four 
weeks of pregnancy, and at the time of the month when 
menstruation would ordinarily occur. Certainly a journey 
should not be undertaken at any time during pregnancy 
without a doctor 's permission. 

Rest and Sleep. When we studied the changes that take 
place during pregnancy we found that as the abdomen in- 
creased in size and weight the expectant mother was re- 
quired to make a constant, though unconscious effort to 
stand upright. This is probably one reason for the fatigue 
which she so often feels without apparent cause, and why, 
upon exertion, she tires more easily than usual. 

Accordingly, you may find it necessary to rest frequently 
during the day in order to avoid the ill effects of fatigue. 
It is a good plan to work and exercise in short periods rather 
than long, always lying down when tired, and for an hour 
or two after the noon meal. You should be careful not 
to be over active or to overexert yourself at the time when 
menstruation would occur if you were not pregnant, for 
fear of bringing on an abortion. This precaution is partic- 
ularly important during the first four months, the period 
when abortions occur most frequently. 



66 GETTING READY TO BE A MOTHER 

Since eight hours' sleep is usually considered necessary 
to keep the average person in good condition, you can 
scarcely expect to get along satisfactorily with less. In fact, 
this is so important to your general well-being that you 
should make a serious effort to secure it. 

Fresh air during the day and open windows at night; 
prudent eating; a comfortable bed furnished with warm 
but light bedding; warm baths; a hot water bag to the feet 
and a hot drink upon retiring are all conducive to sleep. 

But in addition to these, and perhaps of even more im- 
portance, are cheerfulness and a tranquil, untroubled state 
of mind. 

Breasts. Breast feeding is the most urgent single need 
of the baby, for whose coming we are making preparations, 
and practically every mother, excepting those with definite 
physical disability, can supply this need of her baby's if she 
gives herself proper care both before and after his birth. 
You will be glad to know in this connection that everything 
that promotes your general health helps to prepare you to 
nurse your baby, but there is need also for care of the 
breasts and nipples themselves, to make the nursing satis- 
factory, and to prevent sore nipples and possibly even 
breast abscesses. 

Briefly, this local care consists of supporting heavy 
breasts, but avoiding pressure; bringing out flat or re- 
tracted nipples and toughening the skin which covers them. 

After they become heavy and uncomfortable the breasts 
may be supported by brassieres, which are snug below the 
breasts, loose over the breasts themselves and suspended 
from shoulder straps ; or by some such binder as is shown 
in Fig. 11, which answers the same purpose. 

If your nipples are flat or retracted, you should begin 
about the fifth month to make them more prominent in 
order that when the baby nurses he may be able to grasp 



CARE OF THE BABY BEFORE HE COMES 67 

them easily. There are several ways of accomplishing 
this, all of them in the nature of massage, but whatever 
is done must be done regularly and persistently. One sim- 
ple and effective method is to grasp the nipple between the 
thumb and forefinger, draw it out, hold it for a moment, 
then release it and allow it to retract. This should be done 
over and over, two or three times daily. Or the unstoppered 
opening of a warm bottle may be placed over a flat nipple 
and held in place until the nipple is drawn up into the neck 
of the bottle as it cools and a partial vacuum is formed. 

The toughening of the nipples should be begun eight 
weeks before the baby is expected. There are two general 
methods which seem to give about equally satisfactory re- 
sults. One is to soften the skin, and the other is to harden 
it. In either case the nipples should first be scrubbed gently 
with a soft brush or cloth, warm water and soap, for about 
five minutes night and morning. After the scrubbing they 
should be rubbed with lanolin, cocoa butter or vaselin and 
covered with a piece of clean soft cloth or gauze, to protect 
the clothing. Or, they may be bathed with a wash consisting 
of equal parts of a saturated solution of boracic acid and 
95 per cent alcohol. You will probably have to have a drug- 
gist prepare this for you because of the alcohol. 

But no matter which course is followed the care must be 
regular to be effective. You will find that matters will be 
simplified if you will assemble in one place and keep in 
readiness the soap, brush and lotion or ointment which you 
use each time, using them for no other purpose. 

Care of the Teeth. It is very important for the expect- 
ant mother to give her teeth scrupulous care from the be- 
ginning of pregnancy, for in addition to the ordinary wear 
and tear with which we all have to cope, her tendency to 
have an acid stomach makes her mouth acid and this is 
bad for her teeth. Accordingly, in addition to using dental 



68 GETTING READY TO BE A MOTHER 

floss and brushing' your teeth after each meal, you should 
use an alkaline mouth wash several times daily, particularly 
after vomiting and before retiring, for much damage may 
be done by the acid secretions in the mouth if they are al- 
lowed to bathe the teeth during the long night stretches. 
Common baking-soda (a teaspoonful to a tumbler of water), 
lime water or milk of magnesia all make excellent mouth 
washes. It is important, also, that you consult a dentist 
as soon as you know that you are pregnant and have any 
necessary repairs done promptly, for delay may be serious. 

COMMON DISCOMFORTS DURING PREGNANCY 

You may have a number of minor ills and temporary 
disturbances during pregnancy which are not serious but 
capable of making you very uncomfortable, and which you 
may sometimes relieve yourself. But should they be severe 
or persistent, you should consult your doctor at once. The 
most common of these minor discomforts may be grouped 
as digestive disturbances and "pressure symptoms." 

Chief among the digestive disturbances are "morning 
sickness," "heartburn," "distress" and flatulence or 
"gas.'; 

"Morning sickness" is probably the commonest discom- 
fort of pregnancy as it occurs in about half of all cases. 
Because of the expectant mother 's tendency to nausea dur- 
ing the early months, it may be brought on by slight causes 
which would not produce nausea under ordinary condi- 
tions. AVhile it is true that grief, anxiety, fright, shock, 
incessant worry, fits of temper or brooding may induce 
nausea when the diet is entirely satisfactory, nausea and 
even vomiting may be caused in the expectant mother just 
as they may in any one else by indiscretions in diet, rapid 
or over-eating. On the other hand, simple, light food taken 



CARE OP TUP] BABY BEFORE HK COMES 69 

in small quantities, five or six times daily, eaten slowly and 
masticated thoroughly; the cultivation of a happy frame 
of mind; exercise and fresh air ail tend to prevent this 
very uncomfortable condition. 

Prevention is of great importance, as the habit of vomit- 
ing is acquired easily but broken up with difficulty. 

When "morning sickness" occurs, however, the sufferer 
is often relieved by eating two or three hard, unsweetened 
crackers or crisp toast, immediately upon awaking and then 
lying still for half or three quarters of an hour. She should 
then dress slowly, sitting down as much as possible while 
doing so, and eat her regular breakfast. Lying fiat, without 
a pillow for a little while after meals, or whenever having 
the slightest feeling of sickness, will frequently prevent, and 
also relieve nausea. Sometimes comfort is derived from 
the use of either hot or cold applications over the stomach. 
Some expectant mothers find that they can prevent nausea 
by having hot coffee, or even a full breakfast before arising. 
But the habit of having breakfast in bed should not be cul- 
tivated lightly, for in spite of yourself it is likely to make 
you feel like an invalid, the thing you should carefully 
avoid. So don't do it unless your doctor orders it. 

"Heartburn," so called, which is suffered by so many 
expectant mothers, lias nothing to do with the heart. It is 
due entirely to too much acid in the stomach and is usually 
felt as a burning sensation, which starts in the stomach and 
rises into the throat. It may be prevented, as a rule, by 
taking a tablespoonful of olive oil or a cupful of cream or 
rich milk fifteen or twenty minutes before meals and avoid- 
ing fat and fried food at the meals themselves. Or, it may 
be enough simply to avoid eating fats and fatty foods. 
Since the painful, burning sensation is directly due to too 
much acid in the stomach, it usually may be relieved by 
taking a tablespoonful of lime water; a teaspoonful of so- 



70 GETTING READY TO BE A MOTHER 

dium bicarbonate in water; a small piece of magnesium 
carbonate ; or a drink of any alkaline water that one fancies. 

"Distress." Another common discomfort of pregnancy 
is called ' ' distress ' ' by the sufferers themselves, and occurs 
after eating. It may be neither heartburn nor pain, but re- 
semble both and make the expectant mother very miser- 
able. It is usually suffered by women who eat rapidly, do 
not chew their food thoroughly or who eat more at one 
time than the stomach can hold comfortably. This is one 
more reason for taking small amounts of food at a time, 
eating slowly and masticating thoroughly. 

Flatulence, or ' ' gas, ' ' may or may not be associated with 
heartburn, but is fairly common among expectant mothers, 
and is rather uncomfortable. A daily bowel movement is 
of prime importance in preventing and relieving flatulence 
and at the same time foods which form gases should be 
carefully omitted from the diet. The chief offenders are 
parsnips, beans, corn, fried foods, sweets of all kinds, pastry 
and very sweet desserts. Yeast cakes and artificially fer- 
mented milk sometimes help to prevent flatulence. 

Pressure Symptoms. Under the general heading of 
pressure symptoms are several forms of discomfort result- 
ing from pressure of the enlarged uterus (containing the 
baby) on the blood-vessels which return from the lower 
part of the body, thus interfering with the flow of blood 
back to the heart. The commonest pressure symptoms are 
swollen feet, varicose veins, hemorrhoids (piles), cramps in 
the legs and shortness of breath. They may appear at any 
time during the last half of pregnancy and they grow worse 
as the weeks wear on. 

Swelling of the feet is very common, and when very 
slight may not be serious or particularly uncomfortable. 
The swelling may be confined to the back of the ankle, which 
grows white and shining, or it may extend all the way up 



CARE OF THE BABY BEFORE HE COMES 71 

the legs to the thighs. Sitting down, with the feet resting 
on a chair, or lying down with the feet elevated on a pillow 
will give a certain amount of relief. If the swelling and 
discomfort are extreme, the expectant mother may have to 
go to bed until they subside, but very often she will be re- 
lieved by elevating her feet or assuming the right-angled 




Fig. 14. — Right angled position to relieve swelling or varicose 
veins of the feet and legs. (By courtesy of the Maternity Centre 
Association.) 



position shown in Fig. 14, for even a little while, several 
times a day. But while employing these harmless measures 
to make yourself comfortable, you must remember that the 
swelling of your feet and ankles is one of the symptoms that 
your doctor wants to know about. For this reason you 
should promptly report to him even the slightest swelling 
and begin to measure and save your urine for examination. 



72 GETTING READY TO BE A MOTHER 

Varicose veins are not peculiar to pregnancy bnt they 
are among the pressure symptoms which frequently appear 
during the later months, particularly among women who 
have borne children. The enlargement of the veins is not 
usually serious but it may cause a good deal of discomfort. 
While varicose veins may occur in the vulva, they are usu- 
ally confined to the legs, and both legs are about equally 
affected. Sometimes, however, the veins in the right leg are 
more distended than those in the left, or the right side alone 
may be affected. 

Considerable relief may be obtained by keeping off the 
feet, particularly by elevating them, and also by the use 
of elastic bandages. When an expectant mother finds it 
difficult or nearly impossible to sit or lie down for any 
length of time, she may secure great relief in a few moments 
by lying flat on the bed with her legs extended straight into 
the air, at right angles to her body, resting against the wall 
or head board, as shown in Fig. 14. This right-angled posi- 
tion for five minutes, three or four times a day, will accom- 
plish wonders in reducing varicose veins. 

A spiral elastic bandage, also, will give comfort and help 
to prevent the veins from growing larger, if applied freshly 
after each time that the leg is elevated. The most satisfac- 
tory bandages, from the standpoint of expense, comfort and 
cleanliness, are of stockinette or of flannel cut on the bias, 
measuring three or four inches wide and eight or nine yards 
long. If made of flannel, the selvages should be whipped 
together smoothly so that there is neither ridge nor pucker 
at the seam. The bandage should be wrapped around the 
leg with firm, even pressure, starting with a few turns 
over the foot to secure it, and leaving the heel uncovered, 
carried up the leg to a point above the highest swollen 
vessels. As a rule the bandage may be left off at night. 

There are satisfactory elastic stockings on the market, but 



CARE OP THE BABY BEFORE BE COMES 73 

they are fairly expensive, often cannot be washed and 
seem to offer no practical advantage over the bandages. 

Swollen veins in the vulva may be relieved by lying flat 
and elevating the hips, or by lying on the side with the hip? 
elevated on a pillow for a few moments several times a day, 
as shown in Fig. 15. 

Hemorrhoids, or "piles," are virtually varicose veins 
which protrude from the rectum, but, unlike those in the 




Fig. 15. — Lying on the side with hips elevated to relieve swelling 
or varicose veins of the vulva. ( By courtesy of the Maternity Centre 
Association.) 



legs, are extremely painful. As it is the straining in con- 
stipation that causes these enlarged veins to protrude from 
the rectum, this is one more reason for preventing con- 
stipation, for a pregnant woman whose bowels move freely 
every day rarely has hemorrhoids. If hemorrhoids appear, 
and give pain, the first step is to soften the fingers with 
vaselin and gently push the hemorrhoids back into the 
rectum. You can do this quite easily for yourself. You 
should notify your doctor if you have hemorrhoids, but 
while waiting to see him, if you are very uncomfortable 
you will be almost certain to find relief in lying down with 
your hips elevated on one or two pillows; applying an 
ice bag to the rectum, or ice-cold cloths or cloths wrung 



74 GETTING READY TO BE A MOTHER 

from equal parts of water and witch hazel. Sometimes the 
hemorrhoids are worse during the first few days' after the 
baby is born but as a rule they disappear when the ultimate 
cause is removed, which in this case is pressure made by 
the baby. 

Cramps in the legs, numbness or tingling may be caused 
by pressure of the large, heavy uterus upon nerves supply- 
ing the lower extremities. Lying down, applying heat and 
rubbing the painful parts will usually relieve the discom- 
fort. 

Shortness of breath is sometimes very troublesome 
toward the end of pregnancy, and as may be easily under- 
stood, is due to the upward, and not downward pressure of 
the uterus. For this reason the discomfort is made worse by 
lying down and relieved by one's sitting up or being well 
propped up on pillows or a back rest, 

Vaginal Discharge. Although the normal vaginal dis- 
charge is increased during the later months of pregnancy 
you should tell your doctor if your discharge is very free. 
You should not take douches to remove it, unless your 
doctor orders them, for the normal discharge gives you a 
certain amount of protection against infection. If it is irri- 
tating or causes itching or burning you may obtain relief 
by avoiding the use of soap and by bathing the uncom- 
fortable parts with water, containing a teaspoonful of 
sodium bicarbonate to a pint, or with olive oil. 

Itching of the skin is a fairly common discomfort, and 
is possibly a result of irritating material being excreted 
by the skin glands and deposited upon the surface of the 
body. The local irritation usually may be relieved, if not 
very severe, by bathing the uncomfortable areas with the 
solution of sodium bicarbonate as above, or a lotion con- 
sisting of a pint of lime water, half an ounce of glycerin 
and thirty drops of carbolic acid. It is a good plan, also, 



CARE OF THE BABY BEFORE HE COMES 75 

to drink more water, in order to promote the activity of 
the skin, kidneys and bowels, and thus dilute the material 
that may be responsible for the itching and increase its 
elimination through all channels. 

Some women complain of discomfort caused by the 
stretching of the skin over the enlarged abdomen. There 
is a very old belief that rubbing the skin with oil will relieve 
this sensation and also prevent the appearance of the pur- 
plish streaks described in a previous chapter. There seems 
to be little foundation for this belief, but if a woman fancies 
that she is safer and more comfortable after oiling her abdo- 
men, there is certainly no reason why she should not do so. 

HELPING TO PREVENT COMPLICATIONS 

I have described to you the details of personal hygiene 
which your doctor is likely to want you to adopt during 
your months of expectancy, and some of the simple things 
that you may do to relieve minor discomforts when they 
arise, for having these things in black and white may make 
the whole matter a little easier for you. 

But there is still more that yon can do to help the doctor 
help you. You can tell him about any discomfort or any 
new condition that appears, and follow his advice instead of 
talking it over with your family or friends. This will make 
it possible for him to prevent serious complications by 
treating them in the very beginning. 

You have probably learned, in one way or another, that 
the complications associated with childbirth that are most 
serious are infections (childbed fever), convulsions, abor- 
tions or miscarriages and severe bleeding, but perhaps you 
have not heard that you, yourself, can help greatly in the 
prevention of all of these conditions, in your own case, and 
chiefly by little more than exercising good common sense. 



76 GETTING READY TO BE A MOTHER 

Your part in preventing childbed fever, if your baby is 
to be born at home, lies in having in readiness a clean 
room, sterile sheets, towels, gauze pads, etc., as will be de- 
scribed in the next chapter. 

Concerning the other complications we shall say a word 
here. 

Convulsions. You can do a great deal toward preventing 
the condition that causes convulsions by following the 
advice about your personal care that we have just gone over 
and by making it possible for the doctor to treat early 
symptoms promptly. In fact, after looking over the records 
of many thousands of mothers who have had prenatal care, 
it seems almost safe to say that the expectant mother who 
follows such a course will not have convulsions. 

One of the commonest of the early symptoms is headache, 
sometimes persistent and very severe. Others which you 
can detect are blurred vision, spots before the eyes, dizzi- 
ness, vomiting which is more persistent or severe than 
could be called "morning sickness," puffiness under the 
eyes or elsewhere about the face or hands, swelling of the 
feet and ankles and severe pain in the stomach. It might 
be that if you had even one of these symptoms your doctor 
would think it worth while to put you to bed and give you 
nothing but milk, or only water, for a day or two, not be- 
cause you were sick, but to keep you from being so, on the 
same principle that you darn a thin place in a stocking to 
keep a hole from coming. 

In any event, tell your doctor about the symptoms and 
let him decide what is to be done, for therein lies your 
safety. 

Miscarriages. The question of abortions, miscarriages 
and premature births is one of enormous importance, and 
one about which there is a good deal of misunderstanding. 
As to the meaning of the terms, many women are puzzled 



CARE OF THE BABY BEFORE HE COMES 77 

to know the difference between them. Doctors are not likely 
to use the word miscarriage, but will describe as an abor- 
tion a termination of pregnancy which occurs before the 
end of the seventh month and as premature labors those 
occurring from that time until the expected date of confine- 
ment. In the minds of lay people, however, the term 
abortion is often associated with criminal practice, mis- 
carriage being a term loosely applied to all births occurring 
before the seventh month, while the premature baby is the 
one born after the seventh month of pregnancy but before 
the expected date of confinement. 

Of all of these accidents, abortions are the most frequent, 
though in the nature of things it is imposible to say how 
often they occur. They sometimes happen so early in preg- 
nancy that the expectant mother is unaware of the acci- 
dent ; or if she does know of it she may make the mistake 
of taking no notice of it or regard it of so little consequence 
that she does not consult a doctor. But such information 
as is available suggests that at least one out of every five 
pregnancies ends in abortion, the tragedy of this being that 
it is very largely a preventable disaster. 

Since the ovum is insecurely attached to the uterine lining 
until the sixteenth or eighteenth week, an abortion is more 
likely to occur during this time than later, while of this 
period, the second and third months seem to be the most 
perilous. Abortions are less likely to happen during first 
pregnancies than succeeding ones and their frequency seems 
to increase with the number of pregnancies. They occur 
more often among women over thirty-five years than in 
younger ones, and in all cases are most likely to take place 
at the time when menstruation would fall due were the 
woman not pregnant. 

The prevention of abortions is of such obvious importance 
and there is so much that you can do to this end, that we 



78 GETTING READY TO BE A MOTHER 

shall take up the question somewhat at length. Preventive 
treatment really begins very early. In the discussion about 
menstruation we referred to the importance of finding out 
the cause of painful periods, in the interest of good obstet- 
rics, since inflammation of the uterine lining or a mis- 
placed uterus might be responsible for the pain and if neg- 
lected might cause an abortion later on. The correction of 
such troubles, no matter when they are discovered, is an 
early step toward preventing abortions. 

But after pregnancy has actually begun, there are certain 
preventive measures which have proved to be very effective. 
A woman who is pregnant for the first time, and who, there- 
fore, does not know whether she is likely to have an abor- 
tion or not, should avoid such risks as fatigue, sweeping, 
lifting or moving heavy objects, running a sewing machine 
by foot, running, jumping, dancing, traveling or any action 
which might jar or jolt her during the first sixteen or 
eighteen weeks. 

An expectant mother who has had an abortion will have 
to take even greater precautions, as she is in more danger 
than is a woman who has not had this experience. It is of 
prime importance, to begin with, that she have the cause of 
her previous abortion discovered, and if possible corrected. 
And since the accident is most likely to be repeated at about 
the same time, or a little earlier, in each succeeding preg- 
nancy it is a wise precaution for the expectant mother to 
remain quietly in bed for at least a week before and after 
the time when an abortion may be feared. 

Complete rest and relaxation are such effective preventive 
measures that patients with a tendency to have abortions 
who have been willing to stay in bed during most of their 
pregnancy have sometimes been rewarded by going through 
the entire period and in the end giving birth to a normal, 
fully developed baby. As out-of-door exercise is clearly 



CARE OF THE BABY BEFORE HE COMES 79 

impossible in such cases, it is important that the patient 
keep her room very well ventilated all of the time, and 
possibly, under the doctor's direction, have massage or bed 
exercises. 

The marital relation is usually considered inadvisable 
in all cases after the eighth month of pregnancy, and among 
women who have had abortions or miscarriages it is best 
omitted throughout the entire period. This is particularly 
true of women over thirty-five who are pregnant for the 
first time. 

To sum it up in a word, your part in preventing an abor- 
tion or miscarriage after pregnancy lias begun, consists 
largely of avoiding fatigue ; resting when tired ; avoiding 
physical shocks such as blows upon the abdomen, jolts or 
falls particularly during the first sixteen or eighteen weeks 
and at the time when menstruation would ordinarily occur 
if you were not pregnant, and avoiding overwork during 
the later weeks of pregnancy. 

The common symptoms of abortions or miscarriages are 
bleeding, often accompanied by recurring pain, beginning 
in the small of the back and finally felt as cramps in the 
lower part of the abdomen. Since menstruation is sus- 
pended during pregnancy you should always regard bleed- 
ing or a bloody discharge as a symptom of a possible mis- 
carriage, whether you have pain or not. Upon its appear- 
ance you should send for the doctor, go to bed at once and 
keep absolutely quiet. 

Should you be so unfortunate as to have a miscarriage. 
in spite of all your precautions, bear in mind that you will 
need to stay in bed quite as long afterwards and have the 
same care as though you had given birth to a fully devel- 
oped baby. It is because so many women fail to appreciate 
this that abortions and premature births are often followed 
by ill health and invalidism. Under proper care, an abor- 



80 GETTING READY TO BE A MOTHER , 

tion or premature labor is not, of itself, any more serious 
for a woman than a normal delivery. 

Bleeding from the vagina, or a sudden increase in the 
size of the abdomen with perspiration and a sudden feeling 
of faintness, may be the beginning of severe bleeding, or 
hemorrhage, from any one of a number of causes, and in 
such a case the expectant mother should notify her doctor, 
go to bed at once and keep quiet until he arrives. 

Summing up the whole question of preventing complica- 
tions, we find that the following symptoms may be forerun- 
ners of serious trouble and therefore should be watched for 
and reported to the doctor as soon as they are noticed : 

1. Persistent or severe vomiting. 

2. Persistent or severe headache. 

3. Dizziness. 

4. Blurred, vision or the appearance of black spots before the 

eyes. 

5. Puffiness under the eyes, or elsewhere about the face. 

6. Swelling of the feet, ankles or hands. 

7. Sharp pains, particularly in the stomach. 

8. Prolonged failure to feel the baby's movements after they 

have once been felt. 

9. Bleeding, or a bloody discharge. 

10. Pain in the small of the back followed by cramp-like pains 

in the abdomen, before the expected date of confine- 
ment. 

11. Unwarranted mental depression, anxiety or apprehension. 

These are generally accepted as the danger signs of 
pregnancy, any one of which, alone or in combination with 
one or more of the others, is of importance. In addition to 
these it really is important that you talk to your doctor or 
your nurse freely if you are feeling worried or depressed 
about anything at all. Sometimes one feels blue without 
knowing why, and if you should feel so during your preg- 



CARE OF THE BABY BEFORE HE COMES 81 

nancy you should not keep it to yourself but talk it over 
with your doctor or your nurse. 

When all is said and done, what we want for each expect- 
ant mother is little more than that she shall live a nor- 
mal, regular, wholesome life; that she shall be able, and 
what is of equal importance, be willing to weave into her 
everyday life the principles of personal care which every 
one should adopt ; that she shall watch and be watched for 
symptoms of complications throughout the entire period of 
pregnancy, in order that they may be detected early, 
speedily treated and serious troubles thereby prevented. 

The adoption of such simple precautions will pave the 
highroad to health and happiness for yourself and your 
baby. 



CHAPTER VI 
MAKING READY FOR THE BABY 

In making ready for the actual arrival of the baby there 
are several factors to consider, chief among them being- the 
doctor; the nurse; the place where the baby is to be born; 
the room he is to occupy and an equipment which will 
facilitate the care of yourself and the baby, at the time 
of his birth and afterwards. 

Of course you have long since placed yourself under a 
doctor's care, so that is settled. If you are in the care of 
a privately engaged physician, he will, in all probability 
tell you his wishes in regard to your engaging a nurse. 
She should be satisfactory to both you and the doctor from 
the standpoint of training and professional fitness as well 
as her personality. The selection of the nurse, therefore, 
should be made in cooperation with your doctor. It is wise 
to engage her during the early part of your pregnancy 
both to insure your securing the one that you and the doctor 
want especially, and to have that much of the preparation 
off your mind. It is usually a good plan to engage the 
nurse to hold herself in readiness to respond to your call 
at any time after two weeks before the expected date of 
your confinement. Quite reasonably, if she is obliged to 
give up or refuse an engagement in order to hold herself 
available for you, from a given date, she will do so at your 
expense. Try to arrange to have the nurse stay with you 
for six weeks after the baby is born, even though this in- 
volves considerable financial sacrifice on your part. Of 

82 



MAKING READY FOR THE BABY 83 

course if you can afford to keep her still longer, so much 
the better. 

All of this is in case you are in the care of a privately 
engaged physician and are to have a special nurse. If 
you are being cared for during pregnancy by doctors and 
nurses connected with a dispensary, health center or pre- 
natal clinic, they will advise with you about your nursing 
care at the time of confinement and afterwards. 

The next question to consider is whether the baby is to 
be born at your home or in a hospital. The doctor who is 
advising you will have his wishes on this subject, too, and as 
they are entirely in your interest, you will, of course, do 
as he advises. You will be likely to find that for the birth 
of the first baby he will want you to go to a hospital, if 
there is a good one available ; also if you have had any 
symptoms of complications during this pregnancy or diffi- 
culty with previous labors. 

If you are going to a hospital you or your doctor will 
make the necessary arrangements about your room, well in 
advance of the date upon which you expect to go, in order 
to feel sure that a room will be ready for you. 

It sometimes happens, that for a variety of reasons it is 
nearly or quite impossible for the expectant mother to go 
to a hospital, or that her doctor is entirely willing that she 
shall be confined at home. If it is decided that you are 
to remain at home, it will be possible, with a little planning 
and effort on your part, to imitate very nearly in your own 
home the advantages which are offered by a hospital. 

You will remember that in the last chapter I mentioned 
childbed fever as being one of the serious complications, 
associated with childbirth, that could be prevented by care- 
ful work. In the old daj^s, when the importance of cleanli- 
ness was not appreciated, this fever was very common in 
maternity hospitals, but nowadays it seldom occurs in 



84 GETTING READY TO BE A MOTHER 

well conducted institutions because the doctors and nurses 
know how to do clean work and also because they have 
clean things to work with. So if you are to be attended at 
home by a good doctor and a good nurse you may make the 
conditions of your confinement practically ideal by provid- 
ing a clean room and such an outfit of sterile sheets, towels, 
dressings and certain other articles as would be available 
for their use in a hospital. 

Suppose we settle the question of the rooms first. 

It is a very important one but need not be the bugbear 
that some people think it is. In all probability you will 
have no choice as to a room for yourself and will have to use 
the one you ordinarily occupy. Should you have a choice, 
however, it will be well to select one that is cool and shady, 
if the baby is coming during the summer, but one that is 
bright and sunny for occupancy during most of the year. 
It should be conveniently near a bathroom, if possible; 
have an adjoining room for the nurse and one near by for 
the baby. . 

The ideal to work toward is: A room with a washable 
floor with small, light rugs; freshly laundered curtains at 
the windows but no heavy draperies; a single brass or 
iron bedstead, about thirty inches high, with a firm mat- 
tress, and so placed as to be accessible from both sides and 
with the foot in a good light, either by day or night ; a bed- 
side table and two others (folding card tables are a great 
convenience); a bureau; a washstand, unless there is a 
bathroom on the same floor ; one or two comfortable chairs, 
two or three straight chairs and a couch or chaise longwe, 
all of which should be of wood or wicker or covered with 
freshly laundered chintzes. 

Between such a room as this and the one that must be 
used there may be a wide difference, but it will be worth 
while to approach this standard as nearly as possible. It is 



MAKING READY FOR THE BABY 85 

not necessary to make the room bare ; in fact, it should be 
as cheerful and pretty as is compatible with cleanliness. 
There is no objection to pictures on the walls, but the 
room should be free from useless, small articles which are 
likely to be dust catchers, give the nurse unnecessary work 
and occupy space needed for other things. 

The room should be given a thorough house-cleaning 
about two weeks before the baby is expected. If there is a 
carpet on the floor that cannot be taken up conveniently, 
it might be well to have in readiness a large canvas or 
rubber or an abundance of newspapers to protect the floor 
near the bed. If the bed is low, the attentions of the doctor 
and nurse will be made much easier if you have ready four 
solid blocks of wood, of the same size, upon which to elevate 
the bed, after the casters have been removed. The blocks 
should be of such a size as to bring the height of the bed 
up to thirty inches. And it is important, too, to have a large 
board, or table leaves, at hand, to slip under the mattress 
to make it firm, particularly if the bed is soft or sinks in the 
middle. 

The chief requisites for the baby's room are that it may 
be well ventilated and easily cleaned. The floor should be 
of hard wood, or covered with linoleum, in order that it may 
be wiped up with a damp cloth every day, and the walls 
should be freshly papered, or, better still, painted. As bright 
light and glare are bad for the baby the walls would better 
be of a soft shade, such as grayish green or blue, than 
white, and there should be dark shades at the windows, in 
order that the room may be darkened at will. 

The furnishings may consist of a brass or enameled crib, 
with a hair mattress; a chest of drawers; a low straight 
chair and low rocker, both without arms, and a low table 
for the baby's toilet articles. An ordinary kitchen table, 
enameled and with the legs sawed off, serves admirably. All 



86 GETTING READY TO BE A MOTHER 

of the furniture should have smooth, washable surfaces, 
such as hard wood or enamel, and the walls should be 
free from pictures, for the baby's room will have to be 
kept scrupulously clean and free from dust, 

So much for the rooms. 

When it comes to the question of providing the outfit to 
be used in your personal care, the matter of nightgowns 
and the like will be determined by your tastes and your 
means, rather than by specific needs. But six or eight 
nightgowns, a warm bed jacket if the weather is cool, a 
dressing-gown and a pair of slippers, will probably be 
enough to keep you fresh and comfortable, so far as these 
things are concerned, whether you. are in a hospital or at 
home. 

But the preparation of necessary dressings and other arti- 
cles for a home confinement is a different matter and you 
should learn the wishes of your doctor concerning them. 

If his instructions are not specific, you may find that the 
following lists will be helpful guides in assembling an equip- 
ment which will prove adequate to meet the ordinary re- 
quirements of a home confinement. Most of the articles 
listed, or satisfactory substitutes, are to be found in the 
average household, but they should be gotten together in 
one place so as to be ready at a moment 's notice. 

For the Confinement and Your Own Care : 

Plenty of sheets, pillow cases and towels. 

4 sanitary belts. 

1 piece rubber sheeting or oil cloth, 1 x iy 2 yards. 

1 piece rubber sheeting or oilcloth, 2 x iy 2 yards. 

Two or three dozen safety pins. 

Hot water bag with flannel cover. 

1 two-quart fountain syringe. 

1 douche pan. 

1 bed pan. 



MAKING READY FOR THE BABY 87 

2 covered slop jars or covered pails. 

3 basins, about 16, 14 and 12 inches in diameter. 

2 stiff nail brushes, nail scissors and tile or orange stick. 

3 agate or enamel pitchers, holding- at least 1 quart each. 
Medicine glass. 

Medicine dropper. 

2 bent glass drinking tubes. 

100 bichlorid tablets. 

4 ounces chloroform. 

4 ounces boric acid powder. 

4 ounces green soap. 

1 pint grain alcohol. 

Small jar of vaselin to be sterilized. 

Lard, olive oil, vaselin or albolene to oil the baby. 

Roll of adhesive plaster, 1 inch wide. 

One package of absorbent cotton. 

One clinical thermometer. 

In addition to these, a certain supply of sterile dressings 
will be needed. Complete outfits of such dressings, ster- 
ilized and ready for use, may be obtained from any one of a 
number of firms, of which your doctor will know; or they 
may be prepared by the nurse, or you yourself may prepare 
and sterilize the following : 

One dozen towels. 

Three sheets. 

Five or six dozen sanitary pads, about 10 inches long and 4 inches 

wide, made of gauze and cotton batting with a top layer of 

absorbent cotton. 
Two to four bed pads, about 30 inches square and 4 inches thick, 

made of gauze and cotton waste or cotton batting with a top 

layer of absorbent cotton; or of newspapers covered with 

muslin. 
One pair of leggings made of canton- or outing-flannel, either 

loose fitting hose reaching to the thighs or a yard square folded 

diagonally and stitched on one side. See Fig. 16. 



88 GETTING READY TO BE A MOTHER 

Five or six dozen gauze sponges, made by folding pieces of gauze 

18 inches square into small pads with all raw edges inside. 
Two or three dozen gauze squares, 4 inches square. 
Four or five dozen cotton pledgets, or wads of absorbent cotton 

about the size of an egg with the edges drawn together between 

thumb and finger and twisted into a spiral. 
Six pieces of bobbin or narrow tape, 9 inches long, to tie the 

baby's cord. 







^^^^^^H 




B v 


Wiwm 


^Hr ^^s&H^I 


■^ 





Fig. 16. — Two types of easily made leggings, suitable for use at the 
baby's birth. 

To make these supplies you will need about four pounds 
of absorbent cotton, 6 or 8 packages of cotton batting, and 
possibly 40 yards of gauze in addition to cotton-flannel 
for the hose. 

In preparing the dressings for sterilization, you may 
divide them into packages as follows: The sheets in one 
package ; 6 towels in a package ; 6 sanitary pads in a pack- 



MAKING READY FOR THE BABY 89 

age ; 2 delivery pads in a package ; the gauze squares in two 
packages; the leggings in one package; the bobbin in one 
package. The sponges and pledgets should be put up in 
bags or small pillow cases, 2 or 3 dozen in a bag. Wrap each 
package in heavy muslin, either new or old, using pieces 
large enough to well protect the contents from contamina- 
tion by dust or handling, tie them securely with string and 
sterilize as follows : Fill a wash boiler about a quarter full 
of water and fashion a hammock by securely tying a towel 
or strip of muslin to the handles at each end and allowing 
it to hang so that the bottom of the hammock is about 
halfway down in the boiler. As the weight of the dressings 
makes the hammock sag low in the middle it is a wise pre- 
caution to place a rack or support of some kind in the bot- 
tom of the boiler, to hold the dressings well above the 
bubbling water, at the point where they hang lowest. Pile 
the dressings into the hammock, cover the boiler tightly and 
keep the water boiling vigorously for an hour; dry the 
packages in the sun, or by placing them in the oven for a 
few moments, taking care that they are not loosened or 
opened, and at the end of twenty-four hours repeat 
the steaming and drying process, wrap the packages in a 
clean sheet and put them in a drawer or covered box where 
they may remain undisturbed until needed. The nail 
brushes, douche pan and fountain syringe may be wrapped 
in muslin and sterilized in the same way, or the nurse may 
boil them when the time comes to use them. 

Bed pads made of newspapers offer excellent protection 
and are, of course, less expensive than those made of cotton. 
They consist of six or eight thicknesses of newspaper opened 
out to the full size of the page and covered with a piece of 
freshly laundered muslin which is folded over the edges 
and basted in place or held with safety-pins, as shown in 
Fig. 17. These pads may be made virtually sterile by 



90 GETTING READY TO BE A MOTHER 

ironing them on the muslin side with a very hot iron, folding 
the ironed surface inside without touching it, ironing the 
outside after it is folded and wrapping the pads in a clean 
sheet or muslin, also recently ironed, and putting them away 
with the other dressings, in a place protected from dust. 




Fig. 17. — Reverse side of pad made of newspapers and old muslin 
to protect bed during a home confinement. If muslin is held in place 
with safety pins it may be removed easily, washed and used for an- 
other pad. (By courtesy of the Maternity Centre Association.) 

Baby Clothes. In planning the baby clothes, there are a 
few general principles to bear in mind that are of con- 
siderable importance to the baby's welfare. His health 
actually may be injured by having his clothes too warm 
or not warm enough, and also if they are tight enough to 
bind or constrict any part of his body or so ample as to 
form bunches and wrinkles which will make him uncom- 
fortable and restless. 



MAKING READY FOR THE BABY 91 

To be entirely satisfactory his clothes should be simple in 
design and so made as to slip on easily, fit loosely and at the 
same time smoothly; the materials should be soft, light 
and porous. Complete outfits of baby clothes may be bought 
outright, but few expectant mothers are willing to forego 
the sheer ecstasy of fashioning the little garments them- 
selves, while they dream dreams of the baby who is to wear 
them. The following list of garments will meet the baby's 
needs, and those which you may make are really very 
simple : 

Two to four dozen diapers, about 18 inches square. 

Three flannel bands 6 inches wide and 27 inches long, un- 

hemmed. 
Three knitted bands with shoulder straps. 
Three shirts, infants', size 2, of cotton and wool, silk and 

wool but not all wool. 
Four wool and cotton flannel petticoats. 
Four wool and cotton flannel nightgowns. 
Six thin white cotton slips, or dresses. 
Flannel wrapper or a yard square of flannel for extra wrap 

in cool room. 
Cloak and cap or other wrap for out door use in cool weather. 

Let us take these up in turn. 

The diapers may be of any soft, absorbent, loosely woven 
material, such as cheesecloth, stockinette, bird's-eye, cot- 
ton flannel or thin Turkish toweling, single or double thick- 
ness, according to the weight of the material used, and 
about 18 inches square when hemmed. 

The first bands are of cotton and wool flannel, torn 
straight across the width of the material in 6-inch strips 
and left unhemmed. After the cord separates, this band 
is usually replaced by a knitted band with shoulder straps. 

The shirts should have high necks and long sleeves, come 
well down over the hips and open all the way down the 



92 



GETTING READY TO BE A MOTHER 



front. They should be of cotton and wool or silk and wool 
but not all wool as this is too warm. During very warm 
weather the shirts should be of thin cotton or silk. It is 
better to start with size 2 as the smaller size will soon be 
outgrown. 




Fig. 18. — Pattern for baby's petticoat (shoAvn in C. Fig. 20) re- 
quiring % yard of material one yard wide. The cotton dress (A) 
and flannel nightgown (B) in Fig. 20, may be made from this pattern 
with the addition of straight sleeves. 



The petticoat is a very important item in the baby's 
wardrobe, for, helping as it does to keep his body evenly 
warm, it is worn constantly except during very warm 
weather. It should be a straight little slip, about 27 inches 
long, hanging from the shoulders, made entirely of flannel, 
without the broad cotton waistband that has tortured so 
many babies in days gone by. 



MAKING READY FOR THE BABY 



93 



The chief purpose of the dresses or slips is to keep the 
petticoats clean and add to the daintiness of the baby's at- 
tire and they are made, therefore, of very thin, soft cotton 
or linen material. They are made from the same pattern 
as the petticoats, except that they have sleeves and these 




Fig. 19. — Pattern for kimono-style dress or nightgown, shown in E, 
Fig. 20, and requiring I 1 /* yards of material 27 inches wide. 



may be set in or cut out in one piece with the rest of the 
garment like kimono sleeves, as. in Fig. 19. 

The nightgowns are made like the slips, but of the same 
part wool flannel as that used for the petticoats. 

The petticoats, slips and nightgowns should all open 
down the back and may be fastened with either tapes or 
buttons and buttonholes. These fastenings present about 
equal advantages but there is perhaps a slight preference 





« t-i rt w - 

© w o ^ -* s 

O 'H © K 2 W i-T 1 <-l 



-a £T:£i 



O r— I p O "— I 

<o © ^ 



S S 0/ H - 

. ^ ,3 O £ 43 « ,5 « 



MAKING READY FOR THE BABY 95 

for buttons as babies sometimes tangle their fingers in tapes 
or get them in their mouths. 

A satisfactory little wrap to use at first may be made 
from a yard square of soft, warm material with a hood 
formed of one corner by running tapes through casings. 

Patterns for these baby clothes may be obtained from 
two or three of the large pattern concerns, or you may cut 
them out, yourself, by using Figs. 18 and 19 as guides, 
while Fig. 20 shows how the various little garments look 
when finished. 

The question of socks for the new baby is one upon which 
doctors hold different opinions, some believing that the 
warmth provided by the petticoat is sufficient ; others, that 
there is an advantage in the extra protection afforded by 
socks, so you would better learn the wishes of your own 
doctor in this connection. 

Additional Articles Which Are Needed or Useful in the 
Care of the Baby : 

Bath tub, tin, enamel, agate or rubber. 
Drying frames for shirts and stockings. 
Rubber bath apron. 

Flannel, or Turkish toweling bath apron. 
Low chair without arms. 
Low table. 

Screen to protect baby during bath. 
Rack upon which to hang clothes to warm during bath. 
Scales, with beam and basket or scoop, not the spring- 
variety. 
Hot water bag and cover.-- 
Crib, basket or box, to be used as bed. 
Folded felt pad, blanket or hair pillow for mattress. 
Rubber or oilcloth to cover mattress. 
6 crib sheets. 

1 thermometer. 

2 crib blankets. 



96 



GETTING READY TO BE A MOTHER 



Soft towels and wash cloths. 

An old blanket to be used for bath blanket. 

3 or 4 dozen safety pins, assorted sizes. 

Castile soap. 

Boric acid powder. 

Olive oil or albolene. 

Absorbent cotton pledgets, preferably sterile. 

Enamel pail and cover. 

The giving of the baby's daily bath, after he comes, will 
be greatly simplified if you will assemble beforehand and 




Fig. 21. — Baby's toilet tray equipped with jelly glasses, bottles, cellu- 
loid hair receiver for cotton, and a soap dish, as follows: 



1. Safety-pins sticking in cake 

of soap. 

2. Jar for sterile nipples. 

3. Jar of sterile water. 

4. Jar of boracic acid solution. 

5. Nursing bottle. 

6. Sterile water to drink. 



7. Nursing bottle for water. 

8. Small tooth pick swabs. 

9. Liquid petrolatum. 

10. Gauze mouth swabs. 

11. Absorbent cotton. 

12. Soap. 



(By courtesy of the Maternity Centre Association.) 

keep in readiness on a tray or small table, all of the things 
which are to be used each time. Dainty little outfits for this 
purpose may be bought, or you may arrange an entirely 
satisfactory one from jars and bottles to be found in the 
house, as suggested in Fig. 21. 



MAKING READY FOR THE BABY 97 

The above lists of dressings and articles to be used in the 
care of both mother and baby can be considerably modified, 
according to one's tastes and means, and still be satisfactory. 
They merely represent a fair average of what has been 
found adequate to meet the usual needs of the mother and 
baby at home. 

It will be a good plan for you to have in readiness, by 
about the end of the seventh calendar month, all of the 
dressings and other articles to be used during the confine- 
ment. This is in case you should have a premature labor, 
for which the same dressings are needed as in a normal de- 
livery. The baby 's clothes, however, will be in time if they 
are ready by the end of the eighth month. A baby born 
before this time would probably be so frail that he would 
be wrapped in cotton at first, instead of being dressed in the 
clothes ordinarily prepared for a fully developed baby. 

If you will make such preparations for the baby's arrival 
as I have suggested, you will be doing a great deal toward 
securing his safety and well-being, as well as your own. 



CHAPTER VII 
THE BABY'S ARRIVAL 

During the past nine months you have had the happiness 
of guarding the little life within you and of making soft, 
warm garments to have in readiness for the baby when he 
comes. You have prepared your room and his; folded up 
the packages of gauze and cotton and prepared all sorts 
of other things to be pressed into service upon the baby's 
arrival, and through it all you have dreamed and planned 
and built the loveliest of castles in Spain. 

And now, at last, the baby is coming ! 

It almost takes your breath away to realize it after all 
those months of waiting and dreaming, and though it 
scarcely seems possible, the waiting is almost over. 

This same waiting grows very hard toward the end for 
you are tense with expectation and suspense. The hours 
and days seem endlessly long, as they pass without giving 
the looked-for signs that the baby has started. You find 
it very hard not to grow discouraged and impatient, he 
seems so long in coming. Your physical discomfort is ag- 
gravated by the greater pressure made by the baby during 
this period, and you cannot get away from it day or night. 
The desire to urinate is almost constant ; your back aches ; 
your feet feel heavy and swollen and the baby disturbs 
your nights by his increasingly vigorous kicking. 

But this does not last long, so try to minimize the fatigu- 
ing effects of it all by resting and sleeping as much as 
possible during the day. The time does slip by and the 



THE BABY'S ARRIVAL 99 

baby really does come and you don 't want to be tired before 
the big event. 

The miracle of the baby's origin at the moment of con- 
ception; of his growth and the development of the intri- 
cate parts of his little body, is equaled only by the miracle 
of his birth — his separating from your protecting body and 
coming into the world as a new human being when the time 
comes that he is able to exist separately and independently. 

Since very early in pregnancy, you will remember, your 
uterus has been growing alternately hard and soft as the 
muscles have contracted and relaxed. But these contrac- 
tions have been as painless, and so far as we know, as 
fruitless as the contractions of a boy's biceps as he clenches 
his fist and produces a hard lump on his arm. 

But when the baby is ready to take up his life among 
the rest of us human beings, the contractions of your uter- 
ine muscles are altered in such a manner that you gradually 
become conscious of them and they become so purposeful 
that they are able slowh T but steadily to force the baby 
down through that narrow part of the pelvis called the inlet, 
through the cervix, and finally out into the world. 

Since, at the proper time you will be able to help these 
altered muscular contractions to accomplish their high pur- 
pose, you will want to watch their progress, with your 
mind's eye, as far as possible. 

Recall, for a moment, the fact that the baby is contained 
in a sac of fluid in the cavity of the uterus, above the cer- 
vix; that the cervix, below, is a canal drawn in tightly at 
the upper end, or internal os, and also at the lower end, or 
external os. 

Quite evidently after the baby's head has been squeezed 
through the pelvic inlet by pressure of the uterine contrac- 
tions, the cervix must open widely in order that he may 
pass through it, too. And so Nature gradually stretches 



100 GETTING READY TO BE A MOTHER 

this narrow canal by using the lowermost part of the bag 
of waters as a water- wedge and forcing it down into the in- 
ternal os, a little farther with each pain. The opening 
grows wider and wider as the bag of waters is pressed 
farther and farther down into the cervical canal, which also 
widens slowly, and finally the external os, too, is stretched 
wide open by the water-wedge. Fig. 22 shows how the cer- 
vix looks with the bag of waters pressed against the upper 
opening and how the entire canal is gradually dilated by 
this wedge, as it is pressed downward. 

As you doubtless know, the process of your baby's 
emergence into the world and separation from your body is 
termed labor. The onset of labor is usually marked by the 
expectant mother becoming conscious of the uterine con- 
tractions through dragging pains which are felt first in 
the small of the back and then in the lower part of the abdo- 
men and thighs. In the beginning the pains are feeble and 
infrequent, but they gradually grow more severe and more 
frequent. Sometimes the first sign of labor is a gush of 
fluid, caused by the rupture of the membranes, or the 
appearance of blood, but these are not typical. Intestinal 
colic is sometimes mistaken for labor pains by women 
who are pregnant for the first time, but when the cramps 
come regularly and the uterus is felt, through the abdom- 
inal wall, to grow hard as the pain increases, and soft as 
it subsides, there can be no doubt that they are labor pains. 

This is the time, usually, when you will go to the hos- 
pital, if your baby is to be born there, or when you will 
notify your doctor that you think you are in labor. If you 
are to remain at home the doctor may want you to send for 
the nurse at once, in which case he depends upon her to 
communicate with him. Or he may prefer that you notify 
him and let him send the nurse. Either arrangement is 
simple and easy to carry out, but you must be sure that 



102 GETTING READY TO BE A MOTHER 

you understand just what the doctor wants you to do when 
you think labor has started. It is not a bad plan to write 
down his instructions about this, with the telephone num- 
ber and street address of the one to be summoned, so that 
you will know exactly how to proceed when the time comes. 
The entire duration of labor may vary from a few mo- 
ments to several days, but the average length of the first 
labor is about eighteen hours and of subsequent births 
about twelve hours. The process is usually described as 
being divided into the first, second and third stages of labor, 
approximately as follows : 

First stage Second stage Third stage Total 

First labor 16 hours 1% hours 15 minutes 18 hours 

Later labors 11 hours 45 minutes 15 minutes 12 hours 

The first stage begins with the onset of labor and lasts 
until the cervical canal is completely dilated; the second 
stage begins when the cervix is dilated and lasts until the 
baby is born; the third stage begins with the birth of the 
baby and lasts until the afterbirth is expelled. 

First Stage. The pains are mild at first and occur at in- 
tervals of from fifteen to thirty minutes, but they gradually 
increase in frequency and intensity until by the end of 
fourteen to sixteen hours, they are very severe, and recur 
every three or four minutes, each pain lasting about one 
minute. The pains begin in the back, then pass slowly for- 
ward to the abdomen and down into the thighs. 

The average woman is entirely comfortable between pains 
and until they become very frequent she will usually prefer 
to be up and about, but if she is on her feet when a con- 
traction begins she will usually seek relief by leaning for- 
ward on something secure, as the foot of the bed or a table, 
or by sitting down until the pain subsides. As time passes, 
there is an increasing, sometimes persistent desire to empty 



THE BABY'S ARRIVAL 103 

the bowels and bladder because of pressure upon these two 
organs by the baby's head as it is forced slowly downward. 
There may be vomiting, also when the cervix becomes nearly, 
or quite dilated. 

In the course of the stretching process, the cervix sus- 
tains many tiny tears from which blood oozes and tinges the 
vaginal discharge. This bloodstained discharge is often 
called the "show" and usually appears toward the end of 
the first stage. 

When the cervix is fully dilated, the membranes, or bag 
of waters, usually rupture, and there is a sudden gush of 
fluid, but the rupture of the membranes does not neces- 
sarily mark the end of the first stage. Sometimes, though 
not often, they break before labor begins, thus producing 
what is known asa" dry ' ' labor. They may rupture before 
the cervix is fully dilated or they may not rupture at all 
until the doctor punctures them to facilitate the baby's 
birth. 

If the nurse is delayed in reaching you, there is a good 
deal that you can do and have done, during this first stage 
of labor, in the way of preparing for the baby's arrival, 
this preparation relating in general to yourself and to the 
room including placement of the sterile dressings. 

As to yourself, try first to picture what takes place during 
the fifteen or sixteen hours of the first stage. The baby's 
head has usually passed through the pelvic inlet and not 
much happens, now, beyond the widening of the cervical 
canal, as the bag of waters is forced down by the squeezing 
of the uterus each time that it contracts. (See Fig. 23.) 
As the contractions grow stronger and more frequent you 
may have a desire to help matters by "bearing down," or 
straining, but this is very unwise for nothing that you can 
do will hasten the dilation of the cervix. The bearing down 
will tire you and then you will not be able to make as much 



104 GETTING READY TO BE A MOTHER 

helpful effort during the second stage as you would in a 
fresh and rested condition. For this reason, if your pains 
begin at night, don't get up, but stay in bed and try to 
get as much sleep as possible. If they begin during the day, 



Bladder 



^agma 





■_ / 

rer'murrt / 

External OS VI ate r s 



r 



8ac\ 
boTie 



pi 



acedia. 



Fig. 23. — Drawing showing the baby's descent at the time of 
birth. The head is passing through the inlet and pressure by the bag 
of waters has started to dilate the cervix. (Drawn by Max Brodel. 
Used by permission of A. J. Nystrom and Co., Chicago.) 



keep up and about during most of the time, but lie down 
often enough and long enough to prevent your getting tired. 
But above all don't bear down during the first stage. 

Take a. warm soapsuds enema ; a thorough, warm, sponge 
or shower bath, scrubbing the inner surface of the thighs 
and lower abdomen thoroughly, but do not bathe between 



THE BABY'S ARRIVAL 105 

the labia. Put on a freshly laundered nightgown, stock- 
ings, dressing-gown and slippers and braid your hair, pref- 
erably in two braids. 

Drink all of the water you want and about every three 
or four hours take some form of liquid nourishment such 
as milk, cocoa, strained soup or broth, with toast or 
crackers. Such nourishment will help to keep you from 
getting tired and will do no harm, but it may not be alto- 
gether wise to take anything more solid without your doc- 
tor's permission. It is not uncommon for one to feel nause- 
ated toward the end of the first stage and this tendency 
may be aggravated by taking solid food. 

One thing to remember is the very great importance of 
your poise and favorable mental attitude. So much of 
proved value has been done, and still is being done, to 
safeguard you and your baby, that you have every reason 
to feel calm and secure, and it is of very practical im- 
portance that you cultivate this attitude. The woman who 
allows herself to become excited, nervous and apprehensive 
has much harder time than the one who asserts her self- 
mastery and preserves a tranquil state of mind. This is 
so definitely the case that for the sake of your own comfort 
I cannot urge you too strongly to remember it and to 
exclude disturbing or exciting influences as far as possible. 
One of the most troublesome of these is excitable but well- 
meaning and officious friends or relatives. Accordingly, 
if your nurse is not at hand try to have some one cool- 
headed woman with you and insist upon excluding those 
who would be upsetting or likely to offer advice and sug- 
gestions. In getting yourself ready, then, it is advisable to 
take a bath and an enema ; put on clean clothing ; not to 
stay in bed entirely throughout the first stage, but on the 
other hand to try to keep mind and body fresh and rested 
by lying down when you begin to feel tired, taking light 



106 GETTING READY TO BE A MOTHER 

nourishment regularly, not bearing down during pains and 
denying yourself to visitors who might be excitable. 

This is all simple enough and you will not find it diffi- 
cult to carry it out. And, happily, the preparations relating 
to the room are equally simple and uncomplicated. 

Either you or the friend who is with you, may make the 
bed — you if you feel like it, she, if you are tired. The 
mattress is covered with the larger of the two pieces of 
rubber sheeting that you have in readiness and over this is 
placed the lower sheet, stretched very smooth and tight 
and tucked well under the mattress at head, foot and sides. 
If the sheet is not very large, it may be made secure by 
being pinned with safety-pins to the under side of the 
mattress. The smaller rubber is then placed across the 
middle third of the bed and over this a muslin sheet, folded 
once through the middle, tucked well under the sides of 
the mattress. Next, the upper sheet, a light blanket and a 
thin counterpane, all left open at the foot, and a pillow. 

The packages of sterile dressings, douche pan, fountain 
syringe, pitchers and basins may be placed on the tables, 
and the washstand equipped for the doctor's hands with 
soap, sterile nail-brush, nail scissors and file. A large 
kettle or pail of water should be boiled, covered and put 
aside to cool and a large receptacle such as a wash-boiler, 
half or two thirds full of water put on to boil when the 
pains begin to come about every five minutes. 

The baby 's bathtub should be near at hand for sometimes 
babies do not breathe quite satisfactorily at first and are 
helped to do so by being held in a tub of warm water. 
There should be, also, a box, basket or crib, in readiness to 
receive the baby, furnished with a clean blanket and hot- 
water bottle with a flannel cover. 

These are the preparations which may be made during 
the first stage — that period when the cervix is being slowly 



THE BABY'S ARRIVAL 107 

but steadily dilated by the bag of waters as it is forced 
downward by the uterine contractions. You feel these as 
pains beginning in the back, and finally in the lower abdo- 
men and thighs, gradually growing stronger and more 
frequent. 

Second Stage. The first stage is ended, and the second 
stage begins, when the cervix is wide enough for the baby 
to pass through. From this time on you should stay in bed 
and if neither the doctor nor the nurse has arrived, your 
cool-headed friend must stand by and not leave you alone. 
The bag of waters usually, though not always, breaks at 
this time, and there is a rush of fluid. But the character 
of the pains changes even though the membranes do not 
rupture. They come about every two minutes, now, from 
the beginning of one pain to the one following, each pain 
lasting about a minute. They are stronger and more 
forcible and you begin to have an uncontrollable desire to 
strain or bear down. 

If the doctor or nurse is with you. they will tell you how 
to use your pains to advantage, but if they are not there 
you would better avoid bearing down since you want to 
retard the baby's birth, if possible, until one or the other 
arrives. In such a case, you may delay matters by opening 
your mouth and breathing deeply during pains and by 
lying on your side. 

We all know that in spite of the most careful planning, 
babies are sometimes born before the arrival of doctor or 
nurse and that the mother and her cool-headed friend, who 
is standing by, meet the emergency together. Fortunately, 
births occurring under such circumstances are not the ones 
that are likely to be associated with trouble for either mother 
or baby, so there is little or no cause for concern. Most 
doctors feel that the wisest course for the cool-headed friend 
to follow at such a time is to do nothing at all. So if the 



108 GETTING READY TO BE A MOTHER 

baby arrives in advance of the doctor, why, he is here, and 
that is about all there is to it ! The moment you have been 
longing for, for nine long months, has come ; your anxiety 
and waiting are all over, and with much less trouble than 
you expected. 

Third Stage. After the baby is born, your pains will 
subside for a few moments and then the uterus will begin 
again to contract and gradually detach the placenta from 
its inner surface, forcing it out just as the baby was 
expelled. 

In the meantime the baby is lying on the foot of the bed 
with the cord connecting him with the placenta which is 
still within your uterus. Under no circumstances should 
anyone pull on the cord to aid in the expulsion of the pla- 
centa. It will come away, naturally, in due time. When 
the placenta is finally expelled, the third and last stage of 
labor is over. 

In case you and your cool-headed friend feel that some- 
thing should be done, perhaps I would better assure you 
once more that when a baby is born so quickly and easily 
that he arrives before the doctor, you have cause for relief 
only — not anxiety. Practically the only unfavorable con- 
ditions which may arise are hemorrhage in your case and 
failure to breathe satisfactorily, on the part of the baby, 
and you and your cool-headed friend may as well under- 
stand how simply these possibilities may be met. 

Although, as everyone knows, there is normally a certain 
amount of blood lost at the time -of confinement, varying 
from one half to one pint, this is accepted as a matter of 
course. A serious hemorrhage very rarely occurs because 
of one of Nature's ingenious provisions. The tiny muscle 
fibers that make up the uterine wall run in every direction, 
criss-cross, up and down and around, forming a veritable 
tangle. After the placenta comes away, all of these little 



THE BABY'S ARRIVAL 109 

fibers contract, or grow shorter, and the result is that the 
muscles squeeze down upon the blood-vessels so tightly 
that they are closed and blood cannot escape. 

Accordingly, as long as the uterine muscles are contracted 
there can be no hemorrhage. The fortunate thing about 
this is that you can find out if they are contracted, and if 
they are not, you, yourself can stimulate them to do so. 
If you will press your fingers down deep into your abdomen, 
near the navel, you will feel the uterus as a hard round 
mass, which is often likened to a baseball. If it continues 
to feel hard and round there cannot be any serious amount 
of bleeding, but if it becomes soft, the tiny muscle fibers are 
relaxing their grip on the vessels and bleeding may pos- 
sibly occur. Quite naturally the thing to do, then, is to 
stimulate the muscles to contract and this is done by knead- 
ing the uterus through the abdominal wall. You will feel 
it grow hard under your hand and then you will know that 
everything is all right. 

Your friend may want to bathe you and put on a pad 
but it would be better to leave this for the doctor or nurse 
for this reason : Childbed fever is the result of introducing 
infective material into the vagina. Remember that. If no 
germs gain entrance, there will be no childbed fever. When 
your baby came quickly and there was a rush of water, 
your vagina was well washed out. If you and your friend 
keep fingers and everything else away from the vaginal 
outlet and the area immediately surrounding it, it will re- 
main clean and you need not worry about the possibility of 
infection. 

Perhaps I have given more space to all of this than 
seems warrantable, but I want you to know just what is 
going on so that you will not be worried. And also, in order 
that you will not make trouble for yourself by trying to 
do something when all that you really need do is to lie still, 



110 GETTING READY TO BE A MOTHER 

as comfortably as possible, keep your hand on the uterus 
and knead it enough to keep it hard. 

If your friend can slip out the wet sheet and put a dry 
one in its place, without your having to turn over, you will 
be just that much more comfortable, but the doctor will 
attend to everything else when he comes. 

Next the baby. Presumably he is lying there on the foot 
of the bed, all safe and sound, trying to get used to the 
new order of things. He is probably making his presence 
known by crying lustily and though the day may come 
when that sound will not be altogether, pleasant, it is 
nothing short of music to you now, for you have been wait- 
ing a long time to hear it. The baby has come from a very 
warm place and has suddenly undergone the most abrupt 
change in his entire mode of living that he will ever experi- 
ence, so the transition should be made as easy for him as 
possible. There are two things which he must do immedi- 
ately, that your body has been doing for him. He must 
breathe through his lungs and he must keep his body warm. 
If he has cried loudly, your faithful cool-headed friend may 
just wrap a little blanket about him, letting him lie as he 
is until the doctor comes, taking care that his face is not 
covered for he needs plenty of air. If the room is chilly 
she might place a flannel covered bag of warm water beside 
him outside the blanket. 

If the baby has not really cried lustily, as we know that 
even the youngest baby can, he should be made to cry, as 
that is the way he gets his breathing apparatus to running 
as it should. Your friend may take one of the clean little 
gauze squares that you prepared, and wrapping it around 
her little finger reach well back into the baby's mouth and 
remove any mucus that may be lodged there and interfere 
with his breathing. She will do this more easily and thor- 
oughly if she will pick the baby up by the feet, with one 



THE BABY'S ARRIVAL 



111 



finger between his slippery little ankles so that her grip will 
be firm, and wipe out his mouth as he hangs head down. 
The main thing to remember is that the lining of that 




Fig. 24. — Helping the new baby to breathe by holding him head 
downward and sharply spanking him. Note that the nurse has one 
finger between the baby's ankles to prevent his slipping from her 
hand. 



new little mouth is as delicate as a rose leaf and if it is 
wiped with other than the gentlest stroke the surface may 
be injured and give trouble later on. AVhile he is hanging, 



112 GETTING READY TO BE A MOTHER 

head down, your friend may rub his back or stroke it with 
her free hand and in all probability you will then hear the 
baby use his lungs to your heart 's content. But if he still 
does not cry well he may be sharply spanked two or three 
times as shown in Fig. 24. In this picture the cord has been 
cut and the baby is removed from the bed, but that is not 
necessary for it is very common to hold the baby up, wipe 
out his mouth, stroke his back or spank him, before the cord 
is cut. 

You need not be at all disturbed if your baby needs 
these little forms of encouragement, at first, for remember 
that all of a sudden he is given some very complicated and 
taxing work to do and it is only reasonable that he should 
have all possible help as he undertakes it. 

Remember, too, in looking forward to this event, that the 
probability that you or your friend will have to think of 
any of these things is very remote for the doctor and nurse 
are almost certain to be with you, and you will be able to 
give yourself over entirely to being very happy that at 
last your baby has come. 



THE MIRACLE x 
By 

Elizabeth Newport Hepburn 

The wind blows down the street, 

A shutter bangs somewhere, 
While twilight falls as softly as 

A woman's flowing hair. 

Within a quiet room, 

Adventurers at rest, 
A mother holds her new-born son, 

Safe, now, upon her breast! 

For out of Night and Pain, 

The womb of mystery, 
Is sprung this miracle of Life 

That she can touch and see. 

No seer's prophetic dream, 

No star in all the skies 
Burns with a luster half so bright 

As happy mother eyes. 

No questor for the Grail, 

No searcher for the Truth, 
Counts more than those who bear and rear 

And love and nurture Youth! 

Within her curving arm, 

All safe and warm he lies, 
The heir of all that Man has won 

Down countless centuries! 

'Written expressly for "Obstetrical Nursing" by Carolyn Conant 
Van Blarcom. 

113 



CHAPTER VIII 
THE BABY'S MOTHER 

For the first week or two after the baby comes, you will 
be in bed, of course; your doctor will come in often and 
you will doubtless be cared for by a nUrse devoted ex- 
clusively to you, or by a visiting nurse aided by members 
of your family. You will find that it is money well spent 
to keep the nurse, or someone else, to care for and help you, 
for six or eight weeks after the baby's birth, or longer 
if possible. 

Adequate care after childbirth accomplishes two im- 
portant ends. It practically always averts such immediate 
complications as hemorrhage and infection and it prevents 
more or less chronic invalidism. Infection is prevented by 
the scrupulously clean care which is given to your breasts 
and perineum, while hemorrhage is avoided by keeping you 
quiet and closely watching the condition of the uterus. 
Later invalidism is prevented by the many precautions 
which enter into your general care. These relate to your 
position in bed, diet, fresh air, rest, exercise, bathing, atten- 
tion to your bowels ; observance of symptoms and conserv- 
ing all of your forces while increasing your strength. 

All of these details are important, for during the five or 
six weeks after confinement certain changes take place in 
your body which return it very nearly to its pre-pregnant 
state, and lack of watchful care while these changes are in 
progress may retard them and result in your being more 
or less permanently wretched. 

114 



THE BABY'S MOTHER 115 

Make every effort, therefore, to secure the care that you 
need during this transitional period of five or six weeks 
called the puerperium. 

You will doubtless feel a little tired and nervous at first, 
for you have been through something of an ordeal, but 
when one considers the great things that your body has 
accomplished, your recovery and return to a normal condi- 
tion will be surprisingly rapid. During the first few days 
you are likely to have little or no appetite but be very 
thirsty; be constipated; perspire freely and have an in- 
creased amount of urine, which you may have difficulty in 
passing; but these conditions are only temporary. 

In the beginning you will probably be nursed just about 
as anyone would be after a slight operation, with the 
addition of special attention to your breasts and perineum 
to prevent infection, and the toning up of abdominal 
muscles. In order to prevent bleeding and hasten your 
recovery you will be kept very quiet for a day or two, per- 
haps flat on your back ; you may not be allowed to have any 
visitors and your diet, at first consisting of liquids, will 
finally be made up of light, easily digestible but nourishing 
food. 

About the sixth or eighth day you will probably begin to 
sit up in bed and about the ninth or tenth day you may 
be allowed to sit up in a chair for a little while. Some 
young mothers are able to sit up for an hour the first time, 
without fatigue, while others can sit up for only a few 
moments, morning and afternoon, on the first day, grad- 
ually lengthening the period each time that they get up. 
You will probably be able to sit up an hour or so longer 
on each successive day and walk a few steps on the third 
or fourth day after getting up. 

These first few days of being up and trying to walk are 
often tiring, and a little discouraging in consequence, but 



116 GETTING READY TO BE A MOTHER 

of course you will gain steadily, even though it be slowly, 
do a little more each day and gradually feel more and more 
like your old self. 

The mother who has stitches, because of the perineum 
having been torn at the time of the baby's birth, does not 
usually sit up in bed until the ninth or tenth day, when 
the stitches are removed, sitting up in a chair for an hour, 
two or three days later. In connection with tears it may be 
well for you to know that in spite of the most skillful and 
careful efforts to prevent them, tears of some degree usually 
occur when the first baby is born and in about half of the 
confinements that follow. 

But as most tears are very slight and are immediately 
repaired they have little or no effect upon one's comfort 
or general health. 

It is ordinarily considered a safe precaution to avoid 
going up and down stairs until the baby is about four weeks 
old and not wholly to resume normal activities within six 
or eight weeks after his birth. A pinkish or red discharge 
or backache, after the mother gets up are regarded as indi- 
cations that she is not quite ready to do much standing or 
walking and that she still needs a good deal of rest. 

The whole question of the time for sitting up, of getting 
up and of walking about varies so with different individuals, 
as you see, that it is not possible to describe a definite 
routine, for some women recover slowly and would be 
injured by getting up and about at a period which would 
be entirely safe and normal for the majority. The doctor 
has to decide what is best in each case. 

While you are being actually nursed as a bed patient, 
especial attention is given to the bathing of the perineum, 
as has been stated ; the care of the breasts and restoring tone 
to your abdominal muscles, so we may well have a word of 
explanation about each of these details. 



THE BABY'S MOTHER 117 

The Perineum. The nurse will bathe the area between 
your thighs very carefully, at regular intervals, using 
pledgets soaked in some kind of antiseptic solution, and 
put on a fresh one of the sterile pads that you made and 
sterilized some weeks back. This attention is partly to pro- 
mote your comfort and partly to remove any infective 
material that may be present, thus preventing fever. After 
the care that you have had up to this time, it will scarcely 
be possible for you to have childbed fever if all infective 
material is kept away from the vaginal outlet. I speak 
of this in order that you may realize how important it is 
for you to avoid touching these parts with your fingers, 
upon which there are almost certain to be germs. There is 
little doubt that women sometimes seriously infect them- 
selves after the doctor and nurse have taken the most 
scrupulous care to protect them from this very complication. 

Your breasts will be given painstaking care in order that 
the baby may nurse satisfactorily and to prevent both sore 
nipples and breast abscesses. If you cared for your breasts 
during the latter part of pregnancy as was advised in 
Chapter V and will continue to observe ordinary precau- 
tions while the baby is nursing, it is not at all likely that 
you. will have any trouble with your breasts. 

The main features of the care of your breasts, now, are 
keeping the nipples clean and supporting the breasts them- 
selves if they grow heavy enough to be uncomfortable. This 
latter condition is not uncommon about the third or fourth 
day after the baby is born, when the colostrum is replaced 
by what one might call almost a rush of milk. The breasts 
may then become hard, swollen and uncomfortable and 
sometimes a sensitive lump or "cake" may be felt. The 
usual course, nowadays is simply to support those swollen 
breasts and to apply ice bags or hot compresses to the 
painful areas. 



118 GETTING READY TO BE A MOTHER 

There are innumerable bandages and methods for sup- 
porting heavy breasts, any one of which is satisfactory so 
long as it meets the two chief requirements: to lift the 
breasts, suspending their weight from the shoulders, and, 
while fitting snugly below, to avoid making pressure at any 




Fig. 25. — Straight binder for supporting heavy breasts, or holding 
ice caps in place on breasts that are painful. Darts are pinned in 
below the breasts and the binder is held up by shoulder straps, pinned 
on front and back. 



point, particularly over the nipples. One may take a towel 
for example, or a straight strip of muslin, fasten it around 
the chest, pin in darts below the breasts with safety-pins, 
and provide support by means of shoulder straps, attached 
with safety-pins to the front and back of the binder. Fig. 
25 shows such a binder being used to hold ice bags in place, 
for which also it is satisfactory and very easily devised. 




Fig. 26. — Supporting heavy breasts by means of three folded 
towels; one fastened about the waist, one over each shoulder, cross- 
ing front and back. 



119 



120 GETTING READY TO BE A MOTHER 

Three folded towels or folded bands of muslin will pro- 
vide a comfortable support if applied in the sling-like man- 
ner indicated in Fig. 26 ; the Indian binder shown in Fig. 
27, made of cheesecloth or any soft material is cool, light 
and very comfortable, and in addition to these improvised 
binders there are several entirely satisfactory brassieres, 
opening down the front, to be bought in the shops. Happily 
the discomfort from swollen breasts lasts only a day or 
two, for in some mysterious way Nature makes an adjust- 




Fig. 27. — Indian binder for supporting heavy breasts, used at The 
Montreal Maternity Hospital. The tapering ends tie in a knot in 
front. 

ment between the amount of milk produced by the mother 
and that withdrawn by the baby. So as he comes to nurse 
regularly and satisfactorily, the excessive supply of milk 
disappears, and with it the discomfort. 

The care of the nipples practically resolves itself into 
keeping them clean in order to avoid infection. Notice 
that I say keeping them clean, for merely bathing them, 
no matter how regularly, is not enough. The nurse will 
probably bathe your nipples with boracic acid solution and 
sterile cotton pledgets before and after each time that the 
baby nurses, and keep them covered, during the intervals, 
with sterile gauze or cotton. 

Here again you may undo all of the nurse's careful pre- 
cautions against infection, which might cause an abscess, 



THE BABY'S MOTHER 



121 



if you touch your nipples with your fingers or anything 
else that is not sterile, except the baby's mouth. The gauze 
squares or sponges or the 
cotton pledgets that you 
sterilized will serve excel- 
lently to protect your 
nipples between nursings. 
These may be held in place 
by a binder or by tapes 
tied through the ends of 
narrow strips of adhesive 
plaster, four being applied 
to each breast as shown in 
Fig. 28. Strips of adhesive 
plaster about five inches 
long are folded back at one 
end so that two adhesive 
surfaces stick together for 
about an inch. Through a 
hole cut in this folded end 
a narrow tape or bobbin is 
tied, and the strips are 
applied to the breast, be- 
ginning at the margin of 
the darkened area and 
extending outward. The 
free ends of the tapes are 
tied over pads of gauze or 
cotton between nursings, 
and untied to expose the 
nipple at nursing time. 

Lead shields are sometimes used to protect the nipples, 
being held in place by means of a binder. These shields 
should be scoured and boiled dailv. 




Fig. 28. — Sterile gauze held in 

place over nipples by means of 

tapes and adhesive strips. 



m 



122 GETTING READY TO BE A MOTHER 

Method of Nursing. One important reason for all of 
this scrupulous care is that it favors the baby's nursing 
satisfactorily and without interruption, so now you will 
want to know about the actual details of nursing him. 

The baby is usually put to the breast for the first time, 
between eight and twelve hours after he is born. This gives 
the mother an opportunity to rest, and the baby too profits 
by being quiet and undisturbed during this interval. His 
need for food is not great as yet, nor is there much if any 
nourishment available for him. There is no hard and fast 
rule for the mother's position in bed, while nursing her 
baby, beyond the fact that both she and the infant should 
be in a relation that makes the nursing easy. One very 
natural and satisfactory method is for her to turn slightly 
to one side, and hold the baby in the curve of her arm so 
that he may easily grasp the nipple on that side. If you 
take this position you should hold your breast from the 
baby's face with your free hand by placing the thumb 
above and the fingers below the nipple, thus leaving his 
nose uncovered to permit free breathing, as shown in Fig. 
29. You and the baby should lie in such positions that 
both will be comfortable and relaxed and the baby will be 
able to take into his mouth, not only the nipple but much 
of the dark circle as well, so as to compress the base of the 
nipple with his jaws and extract the milk by suction. 

The comfort of this position is sometimes increased by 
laying the baby on a small pillow placed close to the 
mother's side, thus raising his body to the level of his 
head as it rests upon her arm. 

You and the nurse may have to resort to a number of 
expedients in persuading the baby to begin to nurse, for 
he does not always take the breast eagerly at first. He must 
be kept awake, first and foremost, and sometimes suckling 
will be encouraged by patting or stroking his cheek or chin 



THE BABY'S MOTHER 



123 



or lightly spanking his buttocks. If his head is drawn away 
from the breast a little, as he holds the nipple in his mouth, 
he will sometimes take a firmer hold and begin to nurse. 
Moistening the nipple by expressing a few drops of co- 




% 






Fig. 



29. — A comfortable position for mother and baby, while nursing 
in bed. 



lostrum or with sweetened water may whet the baby's 
appetite and thus prompt him to nurse. 

You must be prepared to find the early attempts to nurse 
your baby far from satisfactory, but if you persevere in 



124 GETTING READY TO BE A MOTHER 

making attempts regularly, you will almost certainly 
succeed. 

During the first two or three days the baby obtains only 
colostrum while nursing, but the regular suckling is 
extremely important, not alone for the sake of getting him 
into the habit of nursing but because his suckling is the 




Fig. 30. — Protecting cracked or sore nipples by having the baby nurse 
through a shield. 

best and surest means of stimulating your breasts to pro- 
duce milk. And, as we shall see in a moment, the irritation 
of the nipples in this manner so definitely promotes desir- 
able changes in the uterus that these go on more rapidly 
in women who nurse their babies than in those who do not. 
If your nipples are not sufficiently prominent for the 
baby to grasp them, or if they become sore, you may have 
to use a shield for a while as shown in Figs. 30 and 31, but 
the shield should be discarded as soon as possible for it is 



THE BABY'S MOTHER 



125 




Fig. 3J.— Nipple 
shield used in Fig. 
30. 



the baby's suckling that produces the desired effects. If a 
shield is used, it should be washed and boiled after each 
nursing and kept in a sterile jar or solu- 
tion of boracic acid, between times. 

The length of the nursing periods, 
and the intervals between them, are de- 
cided upon by the doctor according to 
the needs and condition of each baby: 
his weight, vigor, the rapidity with 
which he nurses, the character of his 
stools and his general condition. The 
length of the nursing periods them- 
selves, is usually from ten to twenty 
minutes, the intervals between them 
being measured from the beginning of 
one feeding to the beginning of the next, and are fairly 
uniform for babies of the same age and weight. 

The average baby nurses about every six hours during 
the first two days, or four times in twenty-four hours. 
After this, according to one schedule, he will nurse every 
three hours during the day for about three months and at 
10 p. m. and 2 a. m., or seven times in twenty-four hours. 
From the third to the sixth month he nurses every three 
hours during the day and at ten o'clock at night, or six 
times in twenty-four hours, and from that time until he 
is w T eaned he nurses at four-hour intervals during the day 
and at ten o'clock at night, or five times daily. Such a 
feeding schedule may be arranged in a table as follows: 



First and second days 
First three months . . . 
Third to sixth month. 
After the sixth month 




126 GETTING READY TO BE A MOTHER 

It is becoming more and more common to omit night feed- 
ings after ten o 'clock with the average baby who is in good 
condition even during the first three months. When this 
practice is adopted the baby seems not only to do as well 
as he normally should, but to profit by the long digestive 
rest during the night. Certainly the mother is benefited by 
the unbroken sleep thus made possible. 

As a rule the baby nurses from one side, only, at each 
nursing, emptying the breasts alternately, but if there is 
not enough milk in one breast for a complete feeding both 
breasts may be used at one nursing. Neither you nor the 
baby should go to sleep while he is at the breast, but he 
should pause every four or five minutes to keep him from 
feeding too rapidly. 

After you sit up you will find it a good plan to occupy 
a low, comfortable chair while nursing the baby. Lean 
slightly iorward and raise the knee upon which the baby 
rests by placing your foot on a stool ; support his head in 
the curve of your arm and hold your breast from his face 
though slightly above it, just as you did while nursing him 
in bed. Nurse him in a quiet room where you will not be 
disturbed and where neither your breasts nor the baby 
will be exposed to drafts or the possibility of being chilled. 

Some mothers like to lie down while nursing the baby, 
for in addition to finding the position comfortable they are 
glad to have these regular, though short periods of rest. 

Abdominal Binders and Bed-Exercises. Most women 
are interested in this question as it concerns the restora- 
tion or preservation of the "figure." 

The application of a snug binder for the first day or two 
after the baby comes, is a fairly common practice, for many 
women are very uncomfortable as a result of the sudden re- 
lease of tension on their abdominal walls, a discomfort 
which a binder relieves. And during the first few days 



THE BABY'S MOTHER 127 

after the mother gets up and walks about she is sometimes 
given great comfort by a binder that is put on and snugly 
adjusted about her hips and the lower part of her abdomen, 
as she lies on her back. 

In addition to this, some doctors like to have the young 
mother wear a snug binder throughout her entire stay in 
bed, while others instruct their patients to take bed-exer- 
cises. If the binder is your portion, you have nothing 
to do but Wear it, for some one else must put it on you. But 
if bed-exercises are in order, the following descriptions and 
pictures of the exercises taken by young mothers at the 
Long Island College Hospital may be helpful. 

The day upon which the exercises are started, the rate 
at which they are increased and the length of time during 
which they are continued, are, of course, entirely regulated 
by the doctor according to the strength and needs of each 
patient, for they are never continued to the point of fatigue. 
Quite evidently, then, there can be no definite directions 
for these exercises ; one can give only a description of the 
positions and movements that are frequently used and the 
order in which they are adopted. 

The average mother who is recovering normally begins 
the chin-to-chest exercise from twelve to twenty-four hours 
after the baby's birth. She lies flat on her back and raises 
her head until the chin rests upon her chest. (See Fig. 32.) 
By resting her hand upon the abdomen she feels for her- 
self that the abdominal muscles contract as she lifts her 
head and accordingly realizes that she is actually exercising 
them. The movement is usually repeated twenty-five times, 
morning and evening, every day and continued as long as 
the patient is in bed. 

The familiar deep-breathing exercise comes next and is 
ordinarily started on the third or fourth day. The mother 
lies flat, with her arms at her sides, then extends them 




Fig. 32. 

Figs. 32 to 38 inclusive are bed exercises for the young mother. 
For description see text. (From photographs taken at the Long 
Island College Hospital.) 




Fig. 33. 



128 



THE BABY'S MOTHEK 



129 



straight out from the shoulders (Fig. 33), raises them above 
her head, as in Fig. 34, and returns them to their original 




Fig. 34. 



position. She repeats this exercise ten times morning and 
evening as long as she is in bed. 

The one-leg flexion exercises are not taken by mothers who 




Fig. 35. 



have stitches, but in other cases they are usually started 
about the fifth day. One thigh is flexed sharply on the 
abdomen and the foot brought down to the buttocks as in 



130 GETTING READY TO BE A MOTHER 

Fig. 35. The leg is then straightened out and lowered to 
the bed. This is repeated ten times, with each leg, morn- 
ing and evening, for two or three days. 

The next exercise sometimes replaces the one-leg-flexion 




Fig. 36. 



and sometimes it is taken up in addition to it, being started 
after the former has been done for a day or two, according 
to the strength of the mother. Both thighs are brought up 
on the abdomen in this one, as in Fig. 36, but when the 




Fig. 37. 



legs are straightened the feet are lowered not quite to the 
bed, as in Fig. 37, before being raised again. This is re- 
peated ten times morning and evening. 

Then comes the exercise for which the leg-flexions pre- 



THE BABY'S MOTHER 



131 



pare the mother and which are sometimes discontinued 
when this one is adopted. It is started, as a rule, about 
the seventh day, or two or three days before the mother gets 
up. Both legs are slowly raised to a position at right 
angles to the body, as in Fig. 38, and slowly lowered but not 
far enough for the heels to touch the bed (see Fig. 37), and 
the movement repeated. As this exercise requires a good 




Fig. 38. 



deal of effort it is taken up very gradually, somewhat as 
follows : The legs are raised once in the morning and twice 
in the evening of the first day ; second day. three times in 
the morning and four times in the evening; third day, 
five times in the morning and six times in the evening and 
so on, if the mother is not fatigued, until the exercise is 
repeated ten times or more each morning and evening for 
several months. 

The knee-chest position shown in Fig. 39 is intended 
to prevent a misplacement of the uterus, from which so 
many women suffer after childbirth. It is usually started 
about the seventh day and the patient begins by being 
assisted to that position and keeping it for a moment or 



132 GETTING READY TO BE A MOTHER 

two, gradually lengthening the time to about five min- 
utes each morning and evening ; this is often continued for 
two months or more. 

Walking on all fours is violent exercise and is taken up 
very gradually. Some women are able to attempt it on 
the first day out of bed, if they have been taking the other 
exercises regularly, but as a rule it is not started until 
the second, third or fourth day after getting up. The 
clothes are free from all constrictions, pajamas being very 
satisfactory; the knees are held stiff and straight with 




Fig. 39. — Knee chest position. 

the feet widely separated, to allow a rush of air into the 
vagina, and the entire palmar surface of the hands rests 
flat on the floor. (See Fig. 40.) The patient starts by tak- 
ing only a few steps each morning and evening, gradually 
lengthening the walk to five minutes twice daily and con- 
tinuing it for about two months. It is believed that as 
the young mother walks in this position the uterus and 
rectum rub against each other, producing something the 
same result as would be obtained if it were possible to 
massage them, the effect of this being to promote involution, 
which will be explained later, and lessen the tendency 
toward constipation and uterine misplacement. 



THE BABY'S MOTHER 133 

The general purpose of these exercises, as a whole, then, 
is to strengthen the abdominal muscles, thus helping to pre- 
vent a large, pendulous abdomen ; to increase the con- 
valescing mother's general strength and tone just as exer- 
cise benefits the average person ; to promote involution 
(See page 134) ; to prevent misplacement of the uterus and 
in a measure to relieve constipation. In order that the 




Fig. 40. — Walking on all fours. 

exercises may accomplish these much-to-be-desired ends, 
the doctors who advise them feel that it is important for 
them to be taken with moderation and judgment ; started 
slowly; increased gradually and constantly adjusted to 
the strength of the individual mother. 

Otherwise they ma}" do more harm than good. 

Concerning the changes that take place in your body 
during the puerperium, the ones that will interest you par- 
ticularly are: (1) the shrinkage in the size of your uterus 
and its gradual descent into the pelvis where it was before 



134 GETTING READY TO BE A MOTHER 

the baby began his life within it; (2) the production of 
milk by your breasts; (3) a loss of body weight. 

The Uterus. Immediately after delivery the uterus 
weighs about 2 pounds; is from 7 to 8 inches high; about 
5 inches across and 4 inches thick. The top of the uterus, 
or fundus, may be felt just below the navel and the inner 
surface where the placenta was attached, is raw and bleed- 
ing. At the end of six or eight weeks the organ has de- 
scended into the pelvic cavity and resumed approximately 
its original position and size and its former weight of 2 
ounces. This return of the uterus to practically its pre- 
pregnant state is called involution and in the interest of 
your immediate recovery and future health it is important 
that this shall progress normally. 

There is evidently a close relation between the functions 
of the breasts and of the uterus and accordingly involution 
is likely to progress more satisfactorily in women who nurse 
their babies than in those who do not. The so-called ' ' after- 
pains, ' ' also, are affected by nursing, being more severe, as 
a rule, when the baby is at the breast than at other times. 
These pains are caused by alternate contractions and relax- 
ations of the uterine muscles and are more common in 
women who have had other children than after the first 
baby. These pains usually subside after the first twenty- 
four hours, though they may persist for three or four days. 

In connection with the changes that take place in the 
uterus, the discharge called lochia should be mentioned. 
This is quite profuse and bloody at first but if the uterus 
involutes normally the discharge gradually decreases in 
amount and fades in color, until by the end of the puer- 
perium it has entirely disappeared. 

The Production of Milk. During the first two or three 
days after the baby is born, the breasts secrete a small 
amount of yellowish fluid called colostrum, which differs 



THE BABY'S MOTHER 135 

somewhat from the milk that comes later. About the third 
day the meager amount of colostrum is replaced by milk 
and as this increases rapidly in amount, the breasts usually 
become tense and swollen and sometimes painful; but this 
discomfort generally subsides in a day or two. 

The production of milk is definitely stimulated by the 
baby's suckling and will not continue for more than a few 
days without this stimulation, a fact to be remembered if, 
for any reason, it is desirable to dry up the breasts. The 
end earnestly to be desired is for the breasts to produce 
a quantity and quality of milk which will adequately 
nourish the baby during the first eight or ten months of his 
life, and with proper care and effort this ideal can nearly 
always be realized. But if the mother becomes pregnant 
while nursing her baby — and this sometimes occurs as 
early as a few weeks after childbirth — the quality of her 
milk is likely to suffer. 

The return of menstruation, however, does not necessarily 
affect the milk unfavorably, as is so generally believed. It 
is true that in the ideal course of events, the mother does 
not menstruate while nursing her baby, that is, for eight or 
ten months, but it is probable that about one-third of all 
nursing mothers begin to menstruate about two months 
after confinement and half of those who do not nurse their 
babies begin to menstruate in six weeks. A nursing 
mother may menstruate once and then not again for sev- 
eral months or a year ; or she may menstruate regularly 
and still nurse her bab} r satisfactorily. 

Menstruation is more likely to return early after the 
birth of the first baby than after those born subsequently. 
Mothers sometimes wonder whether this early discharge 
is menstrual or lochial, and though they, themselves, can- 
not possibly distinguish between them, a physician can 
easily decide by examination, and in the interest of the 



136 GETTING READY TO BE A MOTHER 

mother's future health it is important that this uncertainty 
be cleared up. 

The loss of weight is one of the striking changes which 
take place during the puerperium, varying in different 
women from a total loss of from twelve to fifteen pounds. 
Fat women lose more than thin women and those who 
nurse their babies lose more than those who do not. This 
loss may be somewhat controlled, however, by suitable diet 
and under most conditions the mother returns to not less 
than her pre-pregnant weight by the end of the sixth or 
eighth week. You will recall that there was a general gain 
in weight, over the entire bod}^, during pregnancy, in addi- 
tion to the increased weight of the uterus. 

If all goes well, your doctor may not call to see you regu- 
larly after the first couple of weeks, but he will probably 
want to make a thorough examination, sometime about five 
or six weeks after the baby's birth. As this examination 
is a very influential factor in securing your future health 
you should be sure to have it made. A slight abnormality, 
if detected at this time, may usually be corrected with little 
difficulty, but if allowed to persist may result in chronic in- 
validism, or necessitate an operation. In case the uterus is 
not properly involuted, for example, or the perineum is 
found to be flabby, a little more rest in bed is indicated; 
while a uterine misplacement, which seems to occur in about 
a third of all cases, usually may be corrected by the adjust- 
ment of a pessary. Quite evidently, then, it rests with the 
young mother to cooperate with the doctor in guarding 
against future ill health, or even operations, by having this 
final examination made and following whatever course he 
prescribes, as a result of his inspection. 

Most of the discussion in this chapter relates to the care 
that is given to you by others, in preparing you to take up 
life anew, perhaps unaided, and assume the care of your 



THE BABY'S MOTHER 137 

baby. As we shall see in the next chapter, the care of your 
baby, for the next few months, is closely associated with the 
care which you take of yourself and the regulation of your 
daily life. 



CHAPTER IX 

THE MOTHER'S CARE OF HERSELF— 
FOR THE BABY'S SAKE 

Now that you actually have your baby in your arms, soft 
and warm and lovely, you find yourself looking into those 
wide, wondering eyes of his and wanting nothing so much 
as to give him your protection. 

If he could talk, as he looks back at you, I fancy your 
baby would tell you how much your care of him, during 
the months before he was born, has meant, and then he 
would beg you to stand by, very closely, for a few months 
more, until he is a little more used to being a separate 
person living outside your body. 

"You have given me a wonderful start," he seems to tell 
you, "and now I want to go on and develop the best pos- 
sible mind and body. I shall be able to do this if you will 
help me, for what you can give me now is of more impor- 
tance than what all the rest of the people in the world can 
give. You can give me through your milk exactly the 
materials that Nature intends me to use to develop and 
build this partly finished body of mine, and to protect it 
from disease. Just tide me over this most difficult period 
of my life, and I '11 be a credit to us both, not only as a baby 
but as a growing child and later as a robust man or woman, 
helping to do my share of the world 's work. I '11 have fine 
straight limbs to bear me on my way, a good brain to help 
me take a creditable place among people who count, and 
steady nerves I'll have, that will always be dependable. 

138 



THE MOTHER'S (ARE OF HERSELF 139 

I'll put into reality the dreams that you and I are dream- 
ing, and when I do, I'll look back to these early weeks and 
months and realize that I could not have done it but for 
you." 

And so you look into the eyes of this baby of yours and 
pledge yourself to stand by and do for him all that lies in 
your power, realizing already that the keeping of that 
pledge is going to bring you, along with its demands, an 
endless and satisfying happiness; a consciousness that you 
are doing something indispensable to your baby's welfare 
that no one else in the world can do. 

You know, now, that your baby's greatest single need 
for the next few months is satisfactory nursing at your 
breast, but you will be able to give him this only if your 
diet and general mode of living are favorable to the produc- 
tion of good milk. 

Quite evidently, then, your big service to your baby, for 
a while, is largely a matter of caring for yourself. 

It seldom happens that the mother who has had good 
prenatal care, followed by good care during and after 
labor, is unable to nurse her baby if she orders her own 
life in the way that is known to be necessary to promote 
and maintain the production of breast milk. The first 
essential is her real desire to nurse her baby, next, her 
appreciation of the continuous care of herself that is neces- 
sary to this end, and third her whole-hearted willingness 
to take such care, for her baby's sake. 

It is safe to say that if the doctor and the nurse and the 
baby's mother all want him to nurse at the breast, and all 
do everything in their power to make this possible, they 
will almost invariably succeed. This assertion can scarcely 
be made too positively and we should never lose sight of 
the fact that if the baby is not breast-fed he is being 
defrauded, and in the vast majority of cases, because of 



140 GETTING READY TO BE A MOTHER 

insufficient effort on the part of those who are caring for 
him. 

Practically the only conditions which doctors in general 
now recognize as sufficient reason for the mother's not 
nursing her baby are retracted nipples, tuberculosis, con- 
vulsions, severe heart or kidney trouble, certain acute 
infectious diseases such as typhoid fever, and the state of 
pregnancy. 

When none of these conditions exist, a favorable frame 
of mind and a state of good nutrition are the two indispen- 
sable factors in establishing breast-feeding and maintaining 
the production of a satisfactory quantity and quality of 
breast milk. These factors in turn are both affected by the 
mother's general mode of living. 

Women with happy, cheerful dispositions usually nurse 
their babies satisfactorily, while those who worry and fret 
are likely to have an insufficient supply of milk or milk 
of a poor quality. In addition to this sustained influence 
exerted by the nursing mother 's state of mind it is well to 
remember that the quality of milk that has been entirely 
satisfactory may be seriously injured, for the time being, 
by a fit of temper, fright, grief, anxiety or any marked 
emotional disturbance. Actual poisons seem to be created 
as a result of these emotions and they may affect the baby 
so unfavorably as to make it necessary to give him artificial 
food, temporarily, and empty the breasts by pumping or 
stripping before he begins to nurse again. 

I realize that it is not easy entirely to reorganize your 
life and assume new and exacting duties, while recovering 
from an experience resembling an illness in some of its 
effects, and still remain calm, undiscouraged and perpet- 
ually cheerful. But each tiny victory that you accomplish 
in your attempt to achieve this end will bring such satis- 
faction that you will not count the cost. And the incom- 



THE MOTHER'S CARE OF HERSELF 141 

parable, always deepening happiness of watching your very 
own baby grow lovelier and sturdier, day by day, because of 
the things that you, and no one else, are doing, will make 
you deny, even to yourself, that anything you do is hard. 
Particularly will this be true if you repeatedly remind 
youfrrelf that the satisfactorily breast-fed baby is much 
more likely to live through the difficult first year than is 
the bottle-fed baby, and also is much less susceptible to 
disease and infection. 

We shall consider, for a moment, the more important de- 
tails of the routine care that you should give yourself, for 
the baby's sake, and then we shall be ready for the pleasant- 
est task of all — the actual care of the baby himself. 

In general you should try to live just a normal, tranquil, 
unhurried kind of life that is unfailingly regular in its 
daily routine. 

Diet. As was the case during pregnancy, the question 
of your diet is an important one. Throughout the entire 
nursing period your food should be such that it will nourish 
you and also aid in producing milk of a character that will 
meet the baby's needs, the needs of a growing, developing 
body. The best producer of such milk is a diet consisting 
largely of milk, eggs, "leafy" vegetables and fresh fruit, 
all taken with an appetite made keen by constant fresh air. 
Bear this in mind and it will keep you from putting your 
faith in so-called milk-producing foods and nostrums. 

Your meals may well be made up from the groups of 
foods that are suitable for the expectant mother, as given 
in Chapter V. At this time, as during pregnancy, you 
should avoid all food that may produce any form of indi- 
gestion, but for the baby's sake now, as well as your own. 
While it is not generally believed by doctors of to-day, that 
there are many, if any, articles of diet which may in them- 
selves injure the mother's milk, it is generally accepted that 



142 GETTING READY TO BE A MOTHER 

if her digestion is upset this may be, and usually is, bad 
for her milk and therefore bad for the baby. 

Certain drugs are excreted through the milk and may 
affect the baby just as they would if administered to him 
directly, as for example alcohol and opium, from which 
morphine, heroin, codein, laudanum and paregoric are 
derived. 

Although the old belief no longer holds sway, that certain 
substances from such highly flavored vegetables as onions, 
cabbages, turnips and garlic were excreted through the 
milk and upset the baby, it is definitely known that cer- 
tain substances in certain foods are excreted through the 
milk to the baby's great advantage. It is necessary to the 
baby's well-being, therefore, that the nursing mother's diet 
shall include, regularly, those articles of food which contain 
these substances. These foods are milk, egg-yolk, glandular 
organs such as sweetbreads, kidneys and liver; the green 
salads such as lettuce, romaine, endive, and cress and 
the citrous fruits which are oranges, lemons, grapefruit 
and limes. 

These are called "protective foods" because they protect 
the body against certain diseases which will be described in 
the chapter on Nutrition. It is possible for a baby who 
nurses at the breast of a woman whose diet is poor in pro- 
tective foods, to be so incompletely nourished as to be on 
the border line of one of these diseases, or even to develop 
the disease itself. 

It becomes apparent, therefore, that although you did 
not have to ' ' eat for two ' ' before the baby came, you have 
to do so now in certain very important respects. For this 
reason it may be advisable for you to increase the nourish- 
ment provided by your three regular meals by taking a 
glass of milk, cocoa, or some beverage made of milk, during 
the morning and afternoon and before retiring. 



THE MOTHER'S CARE OF HERSELF 143 

The morning and afternoon lunches would better be 
taken about an hour and a half after breakfast and 
luncheon, respectively, in order not to spoil your appetite 
for the meals which follow. It is of considerable importance 
that you take your meals with clock-like regularity and 
enjoy them, as enjoyment promotes digestion ; but at the 
same time you should guard against overeating for fear 
of causing indigestion, as this, you know, is almost sure to 
upset the baby. Rich and highly seasoned foods, in fact 
any articles of food or drink which might upset you, should 
be avoided for the same reason. Drink water freely but 
do not take alcohol nor strong tea or coffee without your 
doctor's permission. 

Summing up the matter of your diet, we find that you 
should have light, nourishing, easily digestible food, consist- 
ing chiefly of cereals, creamed dishes, creamed soups, eggs, 
meat in moderation, salads and the fresh fruits and vege- 
tables that ordinarily agree with you. Many doctors advise 
at least a quart of milk daily, in addition to that which is 
used in preparing the meals and an abundance of water 
to drink. 

Bowels. Your bowels should move freely and regularly 
every day, but you should not take cathartics, or even 
enemata without your doctor's order. You probably will 
be able to establish the habit of a daily movement by taking 
exercise, eating bulky fruit and vegetables, drinking an 
abundance of water and regularly attempting to empty 
your bowels at the same time every day, preferably im- 
mediately after breakfast. 

Rest and Exercise. You will not be likely to thrive, 
nor will the baby, unless you have adequate rest and sleep 
and take daily at least a moderate amount of exercise in the 
open air. You need eight hours sleep, out of twenty-four, 
in a room with the windows open, and as fatigue is bad 



144 GETTING READY TO BE A MOTHER 

for your milk it may be a good plan for you to lie down 
for a while every afternoon. Your exercise will, of course, 
have to be adjusted to your tastes, habits, circumstances 
and physical endurance, for it must always be stopped 
before you are tired. Walking is often the best form of 
exercise that the nursing mother can take and though as a 
rule she may engage in any mild sports that she enjoys, 
violent exercise is inadvisable because of the exhaustion that 
may follow. 

Recreation. Part of the value of exercise lies in the 
pleasure and diversion which it offers, for as we have seen, 
a happy, contented frame of mind is practically indis- 
pensable to the production of good milk. In addition to 
some regular and enjoyable exercise, therefore, you need a 
certain amount of recreation and change of thought and 
environment. If life is monotonous and colorless, the 
average woman is almost sure to become irritable and 
depressed ; to lose her poise and perspective ; to worry and 
fret, and then, no matter what she eats nor how much she 
sleeps, her digestion will suffer, her milk will be affected 
and the baby will pay. This, of course, goes back to the 
question of the young mother 's mental state and the condi- 
tion of her nerves as determining factors in her ability to 
nurse the baby successfully. 

Just here it is important to say a word of caution about 
this very question of your attitude of mind, particularly as 
it relates to your care of yourself. 

It may be that one of the most difficult tasks you will 
have will be that of getting out of the habit of accepting 
the position that borders on being an invalid — of being a 
protected person who is thought about, cared for and con- 
sidered at every turn. This has been your position for 
several months and the most natural result of it all is a 
tendency to cling, perhaps ever so little and even uncon- 



THE MOTHER'S CARE OF HERSELF 145 

sciously, to this very pleasant state. It is not possible for 
anyone to reduce so broad and intangible a subject to 
a few definite words of advice. But think it over for your- 
self and try to strike that happiest of happy mediums that 
lies somewhere between the equally harmful courses of 
coddling yourself and of overdoing. 

A good many doctors think that for the sake of giving 
the nursing mother an opportunity to go out, mingle with 
her friends, take in some music or a play, it is often a 
good plan to replace one breast feeding, sometime in the 
course of each day, with a bottle feeding. The freedom 
which this long interval between two nursings gives the 
mother for diversion and amusement, will often affect her 
general condition so favorably that the quality of her milk 
is definitely better than it otherwise would be and the 
baby is benefited as a result. This single supplementary 
feeding cannot be regarded lightly, however, for it must be 
prepared with the same cleanliness and accuracy as an 
entirely artificial diet, which will be described in the next 
chapter. 

Weaning. One advantage in giving the baby a supple- 
mentary bottle once a day, is that it paves the way for 
weaning, when the time comes to make this change. Under 
ordinary conditions, the mother begins to wean her baby 
about the eighth or tenth month. Having started by re- 
placing one breast feeding, daily, with a bottle feeding, 
she gradually increases the number of bottles given daily 
until the breast feedings are discontinued by the time the 
baby is eleven or twelve months old. There are exceptions 
to this general rule, of course, and under any conditions the 
weaning should always be directed by a doctor, for the baby 
may suffer seriously unless the change in food is skillfully 
made. If the mother's milk is satisfactory and the baby 
is doing well, it is often considered wise not to discontinue 



146 GETTING READY TO BE A MOTHER 

the breast feeding entirely, during the hot summer months 
even though the weaning falls due at this time. 

It was formerly deemed advisable to wean the baby for 
any one of several reasons, but at present the only indica- 
tions for this step which seem to be generally accepted by 
the medical profession, are : pulmonary tuberculosis, acute 
infectious diseases in the mother and pregnancy. Menstru- 
ation was long regarded as incompatible with satisfactory 
nursing, but it is now known that if the mother is taking 
proper care of herself and is in generally good condition, 
the impoverishing effect of menstruation upon the milk is 
usually for the duration of the periods only. It may be 
necessary to supplement the breast feeding with suitably 
modified cows' milk during menstruation, but the baby 
should be put to the breast regularly, just the same, for if 
the stimulation of the baby's suckling is discontinued, the 
temporary reduction in the amount of the milk secreted 
will probably become permanent. 

The state of pregnancy, however, is different, for though 
some women nurse a baby satisfactorily for some months 
after becoming pregnant, it is not considered advisable to 
subject any woman to the combined strain of pregnancy 
and nursing. Moreover, the mother's milk is usually so 
impoverished during pregnancy that the nursing baby 
suffers in consequence. 

Drying up the breasts used to be a great bugbear. 
Lotions, ointments and binders were employed and often a 
breast pump as well. Various drugs were given by mouth 
and the mother was more or less rigidly dieted. It is true 
that some of these measures are still employed and are 
followed by a disappearance of the milk. But at the same 
time, the breasts dry up quite as satisfactorily when none 
of these things are done, provided the baby does not nurse. 
It is not known what starts the secretion of milk in the 



THE MOTHERS CARE OF HERSELF 147 

mother's breasts, but certain it is that absence of the baby's 
suckling stops it. 

If it is left to you to dry up your breasts, your safest 
course will be to do nothing beyond applying a supporting 
bandage, if your breasts are heavy enough to be uncom- 
fortable, and keeping your nipples scrupulously clean. You 
may rely absolutely upon the fact that the baby's suckling 
is the most important stimulation in promoting the activity 
of the breasts and if this stimulation is not given, or is 
removed, the secretion of milk will invariably subside in the 
course of a few days. This is true whether the reason for 
drying up the breasts is that the baby is stillborn or has 
died, or a live baby's nursing is discontinued. It is true 
that the breasts may be swollen and very uncomfortable 
for a day or two, and in addition to a supporting bandage 
the doctor may order sedatives, but the discomfort sub- 
sides as the milk disappears. 

Quite naturally you will not drink an extra amount of 
milk if you are drying up your breasts, but it probably 
will not be necessary to place any other restrictions upon 
your diet. 

In thinking over the nursing period as a whole, we find 
that after all it is a fairly simple matter so to order one's 
life as to promote and maintain a satisfactory supply of 
milk. The milk thus produced is the ideal baby food and 
there is no entirely adequate substitute. Never forget that. 
It gives the baby enormously increased chances of living 
past babyhood and protects him from many diseases. 

Quite evidently breast feeding is every baby's birthright 
and his mother is the only one who can deprive him of it. 



CHAPTER X 

THE MOTHER'S CARE OF HER BABY 

"The mother is the natural guardian of her child; no other 
influence can compare with hers in its value in safeguarding 
infant life." — Sir Arthur Newsholme. 

Before undertaking the care of the new baby, suppose 
we stop for a moment, and consider just what he repre- 
sents ; what he has been through ; what struggles and dan- 
gers are ahead of him; what are the weaknesses of his 
equipment to meet these perils and what must be the 
character of your service to him if you are to do quite all 
in your power to help him safely over this hazardous period 
of early infancy. 

At the time of birth, the baby makes the most complete 
and abrupt change in his surroundings and condition that 
he will make during his entire lifetime. 

•For nine months he has existed under ideal conditions; 
he has been safeguarded from injury ; kept at the tempera- 
ture which was best for him, and above all, has been 
furnished with exactly the proper amount and character 
of nourishment necessary for his growth and development. 
Suddenly he emerges from this completely protecting en- 
vironment into a more or less hostile world, where he must 
assume the task of living, with a frail little body that in 
many respects is only imperfectly developed. And yet the 
baby must not only continue the bodily functions and 
activities that were begun during his intra-uterine life, 

148 



THE MOTHER'S CARE OF HER BABY 149 

but must develop certain functions which were imperfect 
and even establish others which were performed for him. 

You will recall that while within the uterus, the baby 
received his nourishment and oxygen and gave up waste 
material through the placenta. Accordingly, his organs of 
digestion, respiration and excretion are imperfectly de- 
veloped at birth and are capable of functioning only within 
very narrow limits at first. 

His respirations are usually established immediately after 
birth, when he cries vigorously, for his lungs are thereby 
filled with air. The other functions are established more 
gradually and the care of the baby must be such that the 
immature, unused organs will have their development pro- 
moted through activity and yet not be overtaxed. 

The Baby's Condition at Birth. The newborn baby boy 
weighs from seven and a quarter to seven and a half pounds 
and is about twenty inches long, girl babies being perhaps 
a little smaller. His body is well rounded and his flesh 
firm. The skin is a deep pink, or even red, and is covered 
with the cheesy substance called vernix caseosa, which is 
likely to be thickly deposited over the back and in folds of 
the skin and creases, as in the thighs and under the arms. 
Some babies still have, when born, the tine downy hair on 
parts or all of the body, that they had before birth. 

The head and abdomen are relatively large, the chest 
narrow and the limbs short. The legs are so markedly 
bowed that the soles of the baby's feet may nearly or quite 
face each other, but they finally assume a normal position. 
The bones are still soft and the entire body is, therefore, 
very flexible. Some of the bones which unite later in life 
and make the adult skeleton firm and rigid, are separate at 
birth. 

Most newborn babies have faded blue eyes, the permanent 
color appearing gradually, but the amount and color of the 



150 GETTING READY TO BE A MOTHER 

hair varies greatly, some babies being bald, while others 
have abundant hair from the beginning. 

The shape of the baby's head is often badly distorted at 
birth, being so long from chin to crown that the mother is 
deeply concerned. But you may rest quite assured that 
even though badly misshapen, your baby's head in the 
course of a few days will assume the lovely, rounded con- 
tour so characteristic of babyhood. The temporary de- 
formity of the head is caused by a molding and over- 
lapping of the bones of the skull as it is forced through the 
narrow part of the pelvis, the inlet, that we learned about 
in Chapter III. About the middle of the top of the head 
you will be able to feel a soft, diamond shaped spot and 
farther back another soft spot, smaller than the one in 
front and somewhat triangular in its outline. These soft 
places are openings between the bones of the skull and are 
called the anterior and posterior fontanelles. They always 
may be felt on the new baby 's head. 

Growth and Development. The physical progress which 
is made during the first year by average, normal babies who 
are satisfactorily nourished and cared for is fairly uniform 
and the average rate of this progress is somewhat as follows : 

Weight. There is a loss in weight of 6 to 10 ounces 
during the first week of life, after which the baby usually 
gains from 4 to 8 ounces each week, during the first five 
months. Prom this time the gain is only about half as 
rapid, or at the rate of 2 to 4 ounces weekly. At six months, 
therefore, the average baby weighs from 15 to 16 pounds, 
or double the normal birth weight of 7% pounds, and at 
twelve months he weighs from 20 to 22 pounds, or three 
times the average birth weight. Fig. 41 gives an idea of 
how the baby's weight drops during the first week and the 
rate of the normal weekly gain afterwards, during the 
first year. 



5 


V _|_ 


\ ^ 


-£ i 


"-S3L ± 


*^ i 


15 


s ^ 


' T 


\ 


*C X 


^4 


1 IT 


^f T 


5 i 


Sk- 


5£ 


'5 


^v- 


^t 


\ 


A k 1— 


**r 


^v 


^a ^ 


•n 


*L """ 


> \ 


< 5 


Sh t 


"C 


± 3 


2,V - 


sv : 


*s 


v ^X i 


52. 


• 5 


^S 


jc 


s^ 


s ^v 


^v 


v^ 


\ -5> 


V S 


-^ 


-^ 


is 


^ 


^ 


2. : 



bf) 






"". X 1 S" ^ 

SNHNN n rr - 



r-w«vniflf^«MNN 



-= 

em 



ft 



151 



152 GETTING READY TO BE A MOTHER 

The weight is perhaps the most valuable single index to 
the baby 's condition that we have, but at the same time 
it must be remembered that a baby whose food contains an 
excess of sugar or starch may be of normal weight, or over, 
but be incompletely nourished and very susceptible to 
infection, while other babies who are small and gain slowly 
are sometimes very well and vigorous. , Moreover, quite 
commonly there are periods in the lives of entirely normal 
babies during which there is little or no gain in weight. 
This may occur during the period from the seventh to the 
tenth month, for example, or in very warm weather. But 
the doctor is likely to want to watch the baby's weight, 
for when studied in conjunction with other conditions it 
gives a certain amount of information about the baby's gen- 
eral state and progress. 

Height. The height of the average baby at birth is about 
20 inches, though boys may measure a little more and girls 
a little less ; at six months it is about 25 inches and 28 or 29 
inches at the end of a year. 

Head and Chest. The circumferences of the head and 
chest are about the same at birth, the chest being possibly 
a little the smaller of the two. Both measure about 13V2 
inches, gradually increasing to about 16^ inches in six 
months and to 18 inches by the end of the first year. 

Fontanelles. The posterior f ontanelle, the one at the 
crown of the head, usually closes in six or eight weeks 
but the larger, anterior fontanelle is not entirely closed 
until the baby is about eighteen or twenty months old. 

Teeth. Although it occasionally happens that a baby 
has one or two teeth at birth, the average infant has none 
until the sixth or seventh month, when the two lower, cen- 
tral incisors appear. After a pause of a few weeks the 
two upper, central incisors come through, followed by the 
two lateral incisors in the upper jaw. At the end of the 



THE MOTHER'S CARE OF HER BABY 153 



first year, therefore, the average baby has six teeth, or eight 
if the lower lateral incisors have appeared by the first 
birthday, as they sometimes do. This is the usual course 
of dentition, during the first year, as shown in Fig. 42, 
but there are wide variations among entirely well and 
normal babies, the first tooth sometimes not appearing be- 
fore the tenth, eleventh or even twelfth month. As a rule, 



30th Month 
16tnMonth 
22ndMonth 
IZth Month 
5tkJ!ontkf 

llth Month 
ZZndMonth (t 
ibthMonth 
SOihJfontk 




Z4tk Month 
14 th Month 
IS tk Month 



19 th Month 
14th Month 
24 th Month 



Fig. 42. — Diagram showing first, or ' ' milk, ' ' teetli and the ages at 
which they usually appear. 



however, an entire lack of teeth by the time the baby is a 
year old is regarded as an evidence of faulty nutrition. 

The baby who is properly fed and cared for, cuts his 
teeth with little or no trouble, in spite of the widely current 
but seriously mistaken belief that a teething baby is a sick 
baby. We have no way of estimating the number of babies 
who die, needlessly, as a result of this dangerous convic- 
tion, for if the baby is sick while teething, the trouble is all 
too often accepted as a normal occurrence and is not given 
the attention it needs until too late. Frail, delicate babies 
may have convulsions each time that a tooth is cut and if 
a baby is having digestive trouble, this is likely to grow 
worse while he is teething. But cutting teeth is a normal 



154 GETTING READY TO BE A MOTHER 

process and the healthy, properly fed baby suffers little or 
no inconvenience while it is in progress. 

Stools and Urine. During the first two or three days the 
stools are of dark green, tarry material called meconium. 
In the course of two or three days they begin to grow 
lighter and shortly the normal stools appear, these being 
bright yellow in color, of a smooth, pasty consistency and 
having a characteristic odor. During the first month or 




Fig. 43. — Appearance of cord immediately after birth. 

six weeks the baby's bowels may move three or four times 
daily, but after this they usually move but once or twice 
in the course of twenty-four hours. As the nourishment is 
increased, the stools grow somewhat darker and firmer and 
finally become formed. 

The newborn baby's bladder usually contains urine and 
this may be passed immediately after birth or not until 
several hours later. After the first urination the bladder 
may be emptied five or six times a day or oftener. 

The Cord. Within a few days after birth the stump of 
the umbilical cord that is attached to the baby's navel, 



THE MOTHER'S CARE OP HER BABY 155 



begins to shrivel and turn black and a red line appears 
where the cord joins the abdomen. By the eighth or tenth 




Fig. 44. — Appearance of cord four days after birth. 

day, as a rule, the cord has shrunken to a dry. black string, 
when it drops off and leaves an ulcer or small red area 




Fig. 45. — Appearance of navel immediately after cord has dropped off. 

which heals entirely in the course of a few days. Figs. 43, 
44, 45 and 46 show these progressive changes. 



156 GETTING READY TO BE A MOTHER 

Skin. The soft, downy hair that may be remaining on 
the surface of the body usually disappears by the end of 
the first week and there is often a scaling of the skin which 
lasts for two or three weeks, while a delicate pink tint 
replaces the deeper color of the skin in the course of ten 
days or two weeks. The baby does not perspire until after 
the first month, ordinarily, when a very slight perspira- 
tion begins, gradually increasing until by the time the baby 
is a few months old he is perspiring freely. 




Fig. 46. — Appearance of a normal, well healed navel. 

Tears. There are no tears at birth and opinions differ as 
to whether they appear in the course of two or three weeks 
or three or four months. The absence of tears is one reason 
for bathing the baby's eyes so carefully during the early 
days and weeks, for if dust or other foreign material 
gets into the eyes it is not washed out by tears as it is after 
their flow is established. 

General Behavior. During the first few weeks the 
average baby sleeps most of the time ; that is, from 19 to 21 
hours daily. He gradually sleeps less, as the special senses 



THE MOTHER'S CARE OF HER BABY 157 

develop and will sometimes lie quietly for an hour or more 
with his eyes open, sleeping only 16 or 18 hours, daily, at 
six months and 14 to 16 hours at the end of a year. 

The baby begins to make noises and "coo" at about two 
months and to utter various vowel sounds when about six 
months old. By the end of a year these indefinite noises 
and sounds become distinct words. At about the fourth 
month he grasps at objects and smiles, and very soon even 
laughs. He holds up his head at about the third or fourth 
month; sits up and also begins to creep at six or seven 
months, while sometime between the ninth and twelfth 
months he will stand while holding on to something secure 
and begin to walk with assistance. 

These degrees of development at different ages are not 
to be taken as the only measure of normal progress, for some 
well babies mature more rapidly and many others more 
slowly than at the rate which is found to be average. In 
addition to these fairly specific evidences of the baby's 
condition and progress, such as weight, height, strength 
and muscular development, there are other and less definite 
indications of his well-being which should be taken into 
account. 

The baby who is well and is being properly fed in all 
respects, will have good color ; his flesh will be firm ; he will 
take his nourishment with a certain amount of eagerness 
and seem satisfied afterwards. He will sleep for two or 
three hours after each feeding; will sleep quietly at night 
and while awake, unless he is wet or uncomfortable for some 
other good reason, he will seem contented, good-natured 
and happy. 

You have seen how the average, well baby grows and de- 
velops, provided he is given proper care. I want you now 
to have just a glimpse of the other side of the question, so 
that you may realize what happens to the unfortunate little 



158 GETTING READY TO BE A MOTHER 

citizens who are not given such care. This glimpse will 
make you realize more than ever, how worth while are all 
of the precautions that you take for your baby. 

It is estimated that out of every 1000 babies born alive, 
in this country, 40 die during the first month of life, and 
that more than as many again, or about 85 all told, perish 
before reaching the first birthday. 

So hazardous is this period of early infancy, in the United 
States, that our annual loss of baby life is between seven 
and eight times as great as was the yearly loss of our young 
men in the war, for upwards of 200,000 babies less than a 
year old die each year. That the first month is more dan- 
gerous than any which follow is shown by the fact that 
about 100,000 of these baby deaths occur during the first 
four weeks of life. The tragedy of these figures is made 
darker by the fact that at least half of the babies who are 
lost die from preventable causes. In other words, they 
die from lack of proper care. 

That is the point of this for you. These babies die, not 
by an act of Providence, but from lack of care — not the 
difficult, complicated care needed by sick babies but just the 
everyday care which any mother may give — the care that 
keeps well babies well. 

That is what you are going to do — keep your well baby 
well. And you are going to be surprised to find how easy it 
is, after all, to say nothing of the pleasure of it, for the 
thing very nearly sums itself up into feeding your baby 
as the doctor orders and keeping him clean in every par- 
ticular. Bear these two factors in mind for errors in feed- 
ing and lack of cleanliness are the underlying causes of 
the vast majority of baby ills. 

You will often feel a little like Alice in Wonderland, 
who found, one time, that she had to keep running very 
fast to stay where she was, for you will not be able to 



THE MOTHER'S CARE OF HER BABY 159 

relax in a single detail of your baby's care if you are to 
keep him well. With him, as with you, or anyone else, 
the satisfactory use of even ideal food is largely dependent 
upon the general condition and mode of living, and we find 
accordingly, that the question of keeping the baby well 
finally resolves itself into the following common sense re- 
quirements : 

1. Proper food. 

2. Fresh air. 

3. Regularity in the daily routine care. 

4. Cleanliness of food, clothing and surroundings. 

5. Preservation of an even body temperature. 

6. Adequate rest and sleep. 

7. Periodic consultations with your doctor. 

Carve these principles into the tablets of your brain 
and you cannot fail to give your baby the kind of care 
that is literally life-saving. I am going to describe the 
tiny, intimate details of this care, for I think this will help 
you, in the beginning at least, but if you will keep these 
fundamentals in mind and use good common sense you 
really need not read another word about baby care, for 
they give it all in a nutshell. 

Let me warn you emphatically against making the very 
serious mistake of acting upon the advice of friends or 
relatives, no matter how many children they have had. 
These counselors are just as dangerous for babies as they 
are for expectant mothers, so beware of them ! 

"Is it not preposterous," says Herbert Spencer, "that the fate 
of a new generation should be left to the chance of unreasoning 
custom, impulse, fancy, joined with the suggestions of ignorant 
nurses and the prejudiced counsel of grandmothers? To tens of 
thousands that are killed, add hundreds of thousands that sur- 
vive with feeble constitutions, and millions that grow up with 
constitutions not so strong: as thev should be, and vou have some 



160 GETTING READY TO BE A MOTHER 

idea of the curse inflicted on their offspring by parents ignorant 
of the laws of life." 

It is a very wise precaution to have your doctor see 
the baby every week or ten days during the first three 
months and once a month during the remainder of the 
year. Not because he is fragile or ill. Not at all. You 
consult your doctor in order to be sure that you are keeping 
your baby well. 

Did you ever hear of the Chinese custom of paying the 
doctor as long as one is well, but not paying for attention 
during illness? It isn't so very heathenish — that idea of 
paying for the skillful care that will prevent illness. 

In addition to taking the general precaution of seeing 
your doctor periodically, about the baby, be sure to consult 
him about anything that you do not understand or about 
any new condition that arises. You will find any number 
of persons who are ready and eager to advise you, but your 
doctor is the only one whose advice it is safe for you to 
follow. 

The Daily Schedule. The importance of regularity in 
the daily routine of the baby's care cannot be stressed too 
often nor too insistently. No matter how well he is nursed 
in other respects, nor how skillfully the doctor directs his 
care, the baby cannot be expected to progress satisfactorily 
if his life is not absolutely regular. 

Begin by arranging a daily program for the feedings, 
fresh air, bath, sleep and exercise and then allow nothing 
to interfere with your carrying it out. 

The hours for the nursings, which vary with different 
doctors, will constitute the greater part of this daily sched- 
ule. For a baby on four hour feedings, for example, some 
such program as the following may be arranged, while 
for a baby on a three hour schedule a slightly different pro- 
gram may be arranged. 



6 


a.m. 


8 


a.m. 


9 


a.m. 


10 


a.m. 


2 


p.m. 


2 


p.m. 


4 


p.m. 


4 


p.m. 


5:30 


1 p.m. 


5:3C 


» p.m. 


6 


p. ni. 


10 


p.m. 


2 


a.m. 



THE MOTHER'S CARE OF HER BABY 161 

Feeding. 

Orange juice (when ordered). 
Bath. 
Feeding - . 
Out of doors. 
Feeding'. 
:30 to 4 p.m. Out of doors. 

Orange juice (when ordered). 
4 to 5:30 p.m. Indoor airing- and exercises (when ordered). 
Preparation for the night. 
Feeding. 
Feeding. 
Feeding (when ordered). 

YOUR BABY'S FOOD 

Proper feeding is probably the most decisive single fac- 
tor in the routine care of the baby. 

In order that the food shall be satisfactory, it must be 
not only suitable in composition for the individual baby, 
but it must be clean, fresh and at the right temperature ; 
given in suitable amounts and at suitable intervals ; it must 
be given properly — not too fast nor too slowly and it must 
be given under favorable conditions. Moreover, as has been 
stated, the baby, himself, must be kept in a general con- 
dition which will promote the digestion and assimilation of 
the food that is given to him. Fresh air, suitable clothing, 
an even body temperature, gentle handling, proper bath- 
ing, regular sleep, freedom from excitement, fatigue and 
irritation all promote the bady's ability to use his food to 
advantage. Reverse conditions all work against it. Ac- 
cordingly, the actual value of the baby's food to him 
will be largely dependent upon the care that you give him. 

There are three methods of nourishing the baby: by 
breast feeding, by artificial feeding and by a combination 
of the two, termed mixed or supplementary feeding. 



162 GETTING READY TO BE A MOTHER 

Breast Feeding. From all standpoints, maternal nurs- 
ing, under normal conditions, is the most satisfactory meth- 
od of nourishing a baby. If the breast milk is suitable it 
meets all of the baby's requirements and the proportion 
and character of its constituents are exactly suited to his 
digestive powers. In order for maternal nursing to be 
entirely satisfactory, the condition of both mother and 
baby must be favorable. The preparation and care of the 
mother have been described : her general condition and 
state of nutrition; the care and condition of her nipples, 
flat or retracted nipples being brought out if possible, and 
if not, the nursing facilitated by the use of a shield. As 
to the baby, if his diaper is wet or soiled, it should be 
changed before he is put to the breast, partly to make him 
comfortable and partly to avoid disturbing him for this 
after his feeding; and his mouth is gently swabbed with 
boric-soaked cotton, if your doctor so orders. 1 

Although nursing is an instinct, the baby may have to 
learn how to nurse or to acquire the habit, this being one 
reason for putting him to the breast during those first two 
or three days when he obtains little or no actual food, as 
was explained in Chapter IX. As he expresses the milk by 
squeezing and suction made possible only when the nipple 
is well back in his mouth, he must take into his mouth 
practically the entire colored area which surrounds the nip- 
ple. To do this he lies in the curve of his mother's arm 
as she turns slightly to one side, and holds her breast away 
from his nostrils in order that he may breathe freely. 

Sometimes, even when other conditions are favorable, 
the baby is unable to nurse because of some physical dis- 
ability. He may be too feeble, may have a cleft palate 
or find suckling painful because of an injury to the mucous 

1 Boracic acid solution is made by adding one teaspoonf ul of the 
crystals to one cup (half -pint) of boiling water. 



THE MOTHER'S CARE OF HER BABY 163 

membrane which occurred when his mouth was wiped out 
just after birth. The manner in which the baby nurses, 
therefore, may be significant and should be described to 
the doctor if there is any difficulty. 

When the baby has finished nursing he should be taken 
up very gently, held upright against the shoulder for a 
moment or two, to help him bring up gas if he has any, 
and then placed in his crib and left to sleep. If he is 
nursing satisfactorily, he will be sleepy and contented 
afterwards and will sleep for two or three hours; he will 
seem generally good-humored and comfortable while 
awake; he will have good color; gain weight steadily and 
have two or three normal bowel movements daily. The 
normal stool in breast-fed babies is bright yellow, smooth 
and has no evidences of undigested food. 

If the baby is not being adequately nourished, he will 
present exactly the opposite picture, in some or all of 
these respects. He will be unwilling to stop nursing after 
the normal length of time and will give evidence of being 
not satisfied when taken from the breast. He may be list- 
less and fretful and sleep badly. He will not gain weight 
as he should and he may vomit or have colic after nursing. 

To ascertain whether or not such a baby is getting enough 
milk it is customary to weigh him, without undressing him, 
before and after each nursing. Each fluid ounce of milk 
will increase his weight one ounce. If the baby is not ob- 
taining a normal amount of milk at each nursing, he is 
often given enough modified milk after each meal to supply 
the shortage, but at the same time an effort is made to in- 
crease the supply of breast milk by improving the mother's 
personal hygiene, as described in Chapter IX. 

The amount which the baby needs at each feeding varies, 
not only according to his weight and age, but also accord- 
ing to his vigor and activity and therefore must be esti- 



164 GETTING READY TO BE A MOTHER 

mated for each baby. A very general estimate of the 
amount taken by the average, well baby at each feeding, 
is about as follows : 

First week iy 2 to 2 x /2 ounces 

Second and third week 2 to 4 ounces 

Fourth to ninth week 3 to 4% ounces 

Tenth week to fifth month 3V2 to 5 ounces 

Fifth to seventh month 4y 2 to 6V2 ounces 

Seventh to twelfth month Qy 2 to 9 ounces 

Artificial Feeding. There is no entirely adequate substi- 
tute for satisfactory maternal nursing, and any other food 
that is given to the young baby is at best a makeshift. 
Considering the baby's delicacy, therefore, and his urgent 
needs, no pains should be spared to make any artificial 
food that is given to him, as satisfactory as possible. And 
no matter what it costs, he should have only the freshest, 
cleanest and purest milk that can be bought. 

In preparing and giving artificial food it must be borne 
in mind that normal breast milk has the following charac- 
teristics : 

1. It is exactly right in quantity, quality and proportion. 

2. It is fresh, clean and sweet. 

3. It is free from bacteria. 

4. It tends to protect the baby from infection. 

5. It definitely protects him from certain nutritional diseases. 

Cows' milk, suitably modified, is apparently the best 
available substitute for mother's milk, but it must first 
meet certai» requirements and then be handled with scrup- 
ulous cleanliness and care, if it is to be satisfactory. 

The requirements are that the milk shall be : 

1. Whole milk. It must not be altered by the removal of 
cream nor the addition of such preservatives as salicylic 
acid, formaldehyde or boracic acid. 



THE MOTHER'S CARE OF HER BABY 165 

2. Its composition must not vary greatly from day to day. 

3. It must be clean and free from disease germs; other or- 
ganisms should not be present in excessive numbers. 

4. It must be fresh : less than 24 hours old when it is 
delivered. 

All of this means that the milk must come from a herd 
of healthy, tuberculin-tested cows. The milk from a single 
cow may vary markedly from day to day but that from 
several cows is nearly constant. The stables and the cows 
must be kept clean, the udders carefully washed before 
each milking; the milkers themselves must wear freshly 
washed clothing, scrub their hands thoroughly and milk 
into sterile receptacles; the milk must be immediately 
covered and cooled to a temperature of 45° F. or 50° F. 
and kept there. 

Milk produced under such conditions is usually de- 
scribed as ' ' certified milk ' ' and is often prescribed as infant 
food without being pasteurized or sterilized. But if there 
is any doubt about the source of the milk and the method 
of its handling, it should be strained into a clean receptacle 
through filter paper or a thick layer of absorbent cotton 
and subsequently boiled or pasteurized. 

Whether certified or not, the milk should invariably be 
placed in the refrigerator, or some other place which has a 
temperature of 50° F., as soon as it is received, and it muM 
be kept cool and clean. 

Keeping milk cool means keeping it at a temperature of 
50° F. Keeping it clean implies cleanliness not alone of 
the milk itself but of your hands and the utensils that you 
use as well as the destruction of disease germs by pasteuri- 
zation or sterilization. Among the germs which are 
likely to be present in infected milk are those that cause 
diarrhea, sore throats, typhoid fever, diphtheria and scar- 
let fever. 



166 GETTING READY TO BE A MOTHER 

When the doctor makes out the formula for the baby's 
milk, he will adjust the proportions of the different ingre- 
dients to the baby's immediate needs and digestive powers. 
But his careful estimations will be set at naught unless 
you are absolutely accurate in preparing and giving the 
milk. Your invariable responsibility in connection with the 
baby's milk, therefore, is to keep it cooV and clean and be 
accurate. 

You will appreciate the necessity for modifying cows' 
milk before giving it to your baby if you will note the 
differences between mother's milk and cows' milk as indi- 
cated by the following table and consider, too, why Nature 
has made these differences: 

Mother's Milk Cows' Milk 

Fats 3.5 to 4. percent 3.5 to 4. percent 

Sugar 6.5 to 7.5 per cent 4.5 to 4.75 per cent 

Proteins 1. to 1.5 per cent 3.5 to 4. per cent 

Salts .2 per cent .7 to .75 per cent 

Water 87 to 88. per cent 87. per cent 

The various tissues of the body and the bony skeleton are 
built by the proteins and salt. Accordingly Nature sup- 
plies these in greater abundance to the baby calf, who 
grows so fast as to double his birth weight in about forty- 
seven days, than to the baby boy who scarcely doubles his 
birth weight within 180 days. The calf begins life with a 
physical need for the large amount of proteins and salts 
which are present in cows' milk and with digestive organs 
that can cope with them, but the baby needs less, can digest 
less and, therefore, should be given less. There are of 
course, other and finer differences between the two milks 
and an attempt is sometimes make to meet these. For ex- 
ample, mother's milk is slightly alkaline and cows' milk 
slightly acid and the curd of cows' milk is larger, tougher 



THE MOTHER'S CARE OF HER BABY 167 

and harder to digest than that formed by mother's milk. 
Some doctors add lime water to cows' milk, before giving 
it to the baby, to make it alkaline and have the curd made 
softer, finer and more digestible by boiling. 

Articles Needed in Preparing the Baby's Food. A com- 
plete equipment for preparing and giving the baby's milk 
should be assembled, kept in a clean place, separate from 
utensils in general use, and never put to any other service. 
A satisfactory outfit for this purpose comprises the follow- 
ing articles : 

One dozen graduated nursing bottles. 

One dozen nipples. 

Clean, new corks or a package of sterile, non-absorbent cot- 
ton for stoppers. 

Bottle brush. 

Covered kettle, capacity one gallon, for boiling bottles and 
possibly pasteurizing milk. 

Pasteurizer or wire bottle rack. 

Small kettle, about one quart size. 

Graduated pint or quart measuring glass. 

Pitcher, two quart size. 

Long-handled spoon for mixing. 

Funnel. 

Measuring' spoons — table and tea sizes. 

Double boiler. 

Thermometer which will register at least 212° F. 

Cream dipper (if ordered). 

Two small covered jars for sterile and used nipples. 

Sugar (lactose, maltose or cane sugar according to orders). 

Lime water (if ordered). 

Utensils of enamel or aluminum ware are probably the 
most satisfactory ones to use as they are easily kept clean, 
while bottles with wide mouths and curved bottoms and in- 
ner surfaces can be thoroughly washed more easily than 



168 GETTING READY TO BE A MOTHER 

those with small necks and sharp corners. Nipples that 
can be turned inside out to be washed should be selected 
as it is almost impossible to clean thoroughly those with 
tubes or narrow necks. New bottles will be rendered less 
breakable if placed in cold water, which is gradually 
heated, allowed to boil for half an hour and cooled before 
the bottles are removed. 

The bottles should be rinsed with cold water after each 
feeding and then carefully washed and scrubbed with the 
bottle brush in hot soapsuds or borax water, containing two 
tablespoonfuls to the pint. They may be kept full of water 
while not in use or rinsed with hot water and stood upside 
down until they are all boiled on the following morning, 
preparatory to being filled with the freshly prepared milk. 
The baby's bottles should never be washed in dishwater nor 
dried on a towel. The nipples should be rinsed in cold 
water, turned inside out and scrubbed with a brush, in 
hot soapsuds or borax water; rinsed and placed in a jar 
ready to be boiled with the bottles. 

Preparing the Milk. The full quantity of milk which the 
baby will take in the course of twenty-four hours is pre- 
pared at one time and the prescribed amount for each 
feeding poured into as many separate bottles as there will 
be feedings. 

You should begin by assembling on a table everything 
that you will use in preparing the milk formula, as the 
nurse has in Fig. 47. Boil for five minutes all of the 
articles that will come in contact with the milk, including 
the full number of bottles and nipples and the jars in which 
the nipples are kept; remove them with the long-handled 
spoon without touching the edges or inner surfaces, drop- 
ping the nipples into one of the sterile jars. 

Wash the mouth of the milk bottle before removing the 
cap and pour the amount which the formula calls for into 



THE MOTHER'S CARE OF HER BABY 169 



the sterile pitcher. To this is added the sterile water in 
which the sugar has been dissolved in the measuring glass 
and then the potato or barley water, the lime water or soda 
solution as ordered. This mixture is thoroughly stirred 
and the amount for one feeding at a time, measured in 




Fig. 47. — Preparing the baby's milk. (From a photograph taken at 
Johns Hopkins Hospital.) 

the measuring glass and poured into the specified number 
of bottles, which are then stoppered. 

If certified milk is used for the milk mixture it is often 
given to the baby without being pasteurized, in which case 
the bottles are placed in the refrigerator as soon as they are 
filled and stoppered. Very frequently, however, the milk 
is sterilized or pasteurized. You will feel surer of keeping 



170 GETTING READY TO BE A MOTHER 

the mouths of the bottles clean if you cover them with 
squares of gauze or muslin before they are sterilized, hold- 
ing the caps in place with tapes or rubber bands. 

Pasteurization as applied to infant feeding consists of 
heating the milk to 140-165° F. and keeping it at that tem- 
perature for 20 to 30 minutes. 

There are many excellent pasteurizers for home use on 
the market, but entirely satisfactory results may be obtained 
by improvising one from the wire bottle rack seen in Fig. 47, 
and the large kettle already provided. One method is to 
place the rack, containing the bottles, in the kettle which is 
filled with cold water to a level a little above the top of the 
milk in the bottles, and allow the water to come to the 
boiling point. The kettle is removed from the fire, covered 
tightly and the bottles allowed to stand in the hot water 
for twenty minutes. Cold water is then run into the kettle 
to cool the milk gradually and avoid breaking the bottles, 
after which they are placed in the refrigerator, well or 
spring-house and kept at a temperature of 50° F. until 
they are taken out, one at a time, for feedings. If a wire 
rack is not available the bottles may be stood on a saucer 
or a thick pad of folded newspapers in the bottom of the 
kettle. 

Pasteurization does not destroy all germs that may be in 
the milk, but it kills the more important ones and appar- 
ently impairs the nutritive and protective properties of the 
milk less than boiling. However, pasteurized milk must be 
kept cold and must be used within twenty-four hours, for 
the aging of milk is quite as undesirable as souring. 

Scalding is another method of destroying germs in milk. 
The milk is placed in an open vessel and the temperature 
raised to about 180° F., or until bubbles appear around the 
edge and the milk steams in the center, after which it is 
cooled and kept at a temperature of 50° F. 



THE MOTHER'S CARE OF HER BABY 171 

Many doctors prefer to have the baby 's milk boiled, since 
boiling insures absolute sterilization and also renders the 
curd more digestible. Other changes are produced by boil- 
ing, however, which make it important to add orange juice 
and cod-liver oil to the baby's diet at an early date, as 
will be explained in the next chapter. 

Milk may be boiled directly over the flame for a time 
varying from three to forty-five minutes, or it may be 
placed in a double boiler, the water in the lower receptacle 
being cold, and allowed to remain until the water has 
boiled from six to forty-five minutes. 

When" milk is boiled or scalded, the other ingredients are 
added beforehand, as a rule, after which it is measured and 
poured into the bottles. Or the milk mixture may be 
poured into the bottles as for pasteurization and the bottles 
kept in the actively boiling water for any desired length 
of time. 

All of these points, however, are definitely specified by 
the doctor. 

Giving the Baby His Bottle. At feeding time, the bottle 
should be taken from the refrigerator, the stopper removed 
and a sterile nipple taken up by the margin and put on 
the bottle without touching the mouthpiece. The milk is 
brought to a temperature of about 100° F. by standing the 
bottle in a deep cup or kettle of warm water and placing 
it on the fire. The temperature of the milk may be tested 
by dropping a few drops on the inner side of the wrist or 
forearm where it should feel warm but not hot. This 
dropping will also indicate if the hole in the nipple is of 
the proper size to allow the milk to drop rapidly in clean 
drops but not to pour. If the hole is too small, the drops 
will be small and infrequent and the baby will be obliged 
to work too hard to obtain it ; while if the hole is too large 
the baby will feed too rapidly and may have colic as a 



172 GETTING READY TO BE A MOTHER 






result. If the hole is too large the nipple will have to be 
discarded; if too small or if there is no hole, one of the 
proper size may be made by piercing the nipple with a 
heated darning needle or small steel knitting needle. 




Fig. 48. — Proper position in which to hold baby and bottle during 

feeding. 



THE MOTHER'S CARE OF HER BABY 173 

The baby's diaper should be changed if it is soiled or 
wet before he is given the bottle and he should be held com- 
fortably on your arm, in a reclining position, while you 



Fig. 49. — Holding the baby upright immediately after feeding, 
and gently patting his back to help him bring up air in order to 
prevent colic. 

hold the bottle with your free hand as shown by the nurse 
in Fig. 48. The bottle should be inclined sufficiently to 
keep the neck full of milk ; otherwise the baby may draw in 
air as he nurses. He should be kept awake while feeding 



174 GETTING READY TO BE A MOTHER 

but he should be allowed to pause every three or four min- 
utes in order not to take his milk too rapidly. Not less 
than ten nor more than twenty minutes is devoted to a 
feeding, as a rule, and if the baby refuses a part of his 
milk, it should be thrown away; never warmed over for 
another time. 

After being fed, the baby should be held upright against 
your shoulder for a moment or two, as in Fig. 49, and ever 
so gently patted on the back to help bring up any air 
which he may have swallowed. He should on no account 
be rocked nor played with after taking the bottle, but should 
be placed gently in his crib, warm and dry and left alone 
to sleep. Turning him or moving him about even to the 
extent of changing his diaper at this time may cause vomit- 
ing. 

The evidences of satisfactory and unsatisfactory feeding 
in the bottle-fed baby are about the same as in the baby 
who is fed at the breast, except that the gain in weight on 
artificial food may be a little slower and less steady than on 
maternal nursing; the stools have a characteristic sour 
odor; are a little lighter in color and may contain white 
lumps of undigested fat ; are usually dryer than in breast- 
feeding and may be formed, in even a very young baby. 

Many doctors feel that all babies, whether breast-fed 
or on the bottle, require a certain amount of cool boiled 
water to drink between feedings. A small amount is given 
at first and gradually increased according to the doctor's 
instructions, and it may be given from a bottle, a medicine 
dropper or poured slowly from the tip of a teaspoon. 

I feel sure that you have realized, long before this, that 
the entire question of planning the baby's food is such an 
important and complicated matter that it cannot with 
safety to the baby be undertaken by any one but your doc- 
tor. Unexpected situations do arise, however, when the 



THE MOTHER'S CARE OF HER BABY 175 

doctor is not within immediate reach and the mother has 
to plan the baby's food, temporarily, to the best of her 
ability. 

Should you find yourself in such an emergency, you will 
find help in the milk formulas contained in a pamphlet 
issued by the American Medical Association, remembering 
that they are intended for the average, normal baby and are 
not necessarily suitable for all babies. A large, vigorous 
baby may need more food and a small, frail baby have to 
take less than the amounts specified in the following direc- 
tions r 1 

"The simplest plan is to use whole milk (from a shaken 
bottle) which is to be diluted according to the child's age and 
digestion. 

"Beginning on the third day, the average baby should be given 
3 ounces of milk daily, diluted with seven ounces of water. To 
this should be added one tablespoonful of lime water and 2 level 
teaspoonfuls of sugar. This should be given in 7 feedings. 

"At one week, the average child requires 5 ounces of milk 
daily, which should be diluted with 10 ounces of water. To this 
should be added iy 2 even tablespoonfuls of sugar and one ounce 
of lime water. This should be given in 7 feedings. 

"The milk should be increased by V2 ounce about every 4 days. 

"The water should be increased by Yi ounce about every 8 
days. 

"At 3 months the average child requires 16 ounces of milk 
daily, which should be diluted with 16 ounces of water. To this 
should be added 3 tablespoonfuls of sugar and 2 ounces of lime 
water. This should be given in 6 feedings. 

"The milk should be increased by 1 -> ounce about every 6 
days. 

"The water should be reduced by V2 ounce about every 2 
weeks. 

1 From ' ' Save The Babies ' ' by Dr. L. Emmet Holt and Dr. H. K. 
L. Shaw. Copied by courtesy of The American Medical Association. 



176 GETTING READY TO BE A MOTHER 

"At 6 months the average child requires 24 ounces of milk 
daily, which should be diluted with 12 ounces of water. To this 
should be added 2 ounces of lime water and 3 even tablespoonf uls 
of sugar. This should be given in 5 feedings. 

"The amount of milk should be increased by ^ ounce every 
week. 

"The milk should be increased only if the % child is hungry and 
digesting his food well. It should not be increased unless he is 
hungry, nor if he is suffering from indigestion even though he 
seems hungry. 

"At 9 months, the average child requires 30 ounces of milk 
daily, which should be diluted with 10 ounces of water. To this 
should be added 2 even tablespoonfuls of sugar and 2 ounces of 
lime water. This should be given in 5 feedings. 

"The sugar added may be milk sugar or, if this cannot be 
obtained, cane (granulated) sugar or maltose (malt sugar). 

"At first plain water should be used to dilute the milk. 

"At 3 months, sometimes earlier, weak barley water may 
be used in the place of plain water ; it is made with y 2 level 
tablespoonful of barley flour to 16 ounces of water and cooked 
20 minutes. 

"At 6 months the barley flour may be increased to l 1 ^ even 
tablespoonfuls, cooked in the 12 ounces of water. 

"At 9 months, the barley flour may be increased to 3 level 
tablespoonfuls, cooked in the 10 ounces of water. 

"A very large baby may require a little more milk than that 
allowed in these formulas. A small delicate baby will require 
less than the milk allowed in the formulas." 

These formulas may be tabulated as shown on p. 177. 

Mixed Feeding. Under some conditions the breast-fed 
baby is given also a certain amount of modified milk, and 
this combination of natural and artificial feeding is termed 
mixed or supplementary feeding. 

A deficiency in the breast milk, ascertained by weighing 
the baby before and after each nursing, may be supplied 



THE MOTHER'S CARE OF HER BABY 177 



by following each nursing with a bottle feeding; or for 
some reason, one or two breast-feedings, in the course of 
the day are sometimes replaced by entire bottle feedings. 
In any case the milk mixture to be used as supplementary 
feeding is prepared with exactly the same painstaking care 
as is the milk for entire artificial feeding. 

If supplementary food is given because of an inadequate 
supply of breast milk, it is of great importance that the 
baby be put to the breast regularly, no matter how little 
food he obtains, for his suckling is the best possible means 
of stimulating the breasts to secrete more milk, and of equal 



Age 



Milk 



Water 



Barley- 
Water 



Lime- 
Water 



Sugar 



No. of 
feed- 
ings 



Hours 



Day I Night 



3-7 days 


3 ozs. 


7 ozs. 




A ozs. 


2 teaspoons 
\Yi tablespoons 


7 


6-9-12-3-6 


10-2 


2d week 


5 " 


10 " 




1 


7 


6-9-12-3-6 


10-2 


3d " 


6 " 


10^ " 




1 


m 


7 


6-9-12-3-6 


10-2 


1 month 


7 " 


11 " 




1 " 


2 


7 


6-9-12-3-6 


10-2 


2 " 


11 " 


13 " 




\Vi " 


VA 


7 


6-9-12-3-6 


10-2 


3 " 


16 " 




16 ozs. 


2 " 


3 


7 


6-9-12-3-6 


10-2 


4 " 


19 " 




15 " 


2 " 


3 


6 


6-9-12-3-6 


10 


5 " 


2VA " 




14 " 


2 " 


3 


6 


6-9-12-3-6 


10 


6 " 


24 " 




12 " 


2 " 


3 


5 


6-10-2-6 


10 


7 " 


26 " 




12 " 


2 " 


3 


5 


6-10-2-6 


10 


8 " 


28 " 




11 " 


2 " 


2V 2 


5 


6-10-2-6 


10 


9 " 


30 " 




10 " 


2 " 


2 


5 


6-10-2-6 


10 



importance is the fact that they will tend to dry up if the 
baby nurses less than about five times in twenty-four hours. 
Moreover, even a little breast milk is valuable to him and 
he should have the benefit of all there is to be had. 

An entire bottle feeding is sometimes given to a baby 
who is nursing satisfactorily at the breast, in order to give 
his mother an opportunity to take longer outings than are 
possible between the regular nursings. And sometimes it 
is to the mother's advantage, and therefore to the baby's, 
to give him a bottle during the night and thus allow her to 
sleep undisturbed. 



178 GETTING READY TO BE A MOTHER 

COMMERCIAL BABY FOODS 

Since the baby's nourishment is prescribed by the doc- 
tor, you have no reason to concern yourself with the vari- 
ous proprietary baby foods and canned and powdered milks 
that are so persuasively advertised to young mothers. And 
I earnestly hope that by the time you finish this little book, 
no one will be able to make you believe that any of these 
foods is likely to be satisfactory if used as a sole article 
of diet throughout the bottle-feeding period. 

Unquestionably there are many times and circumstances 
when the temporary or supplementary use of a prepared 
infant food or canned or powdered milk is advantageous. 

In some cases of intestinal disturbance a proprietary food 
may be a great boon, or while the mother is traveling and 
is unable to have freshly prepared milk formulas supplied 
to her along the way. These foods may be valuable, also, 
during the summer, while one stays at a hotel or boarding 
house where the freshness, cleanliness or purity of the milk 
are uncertain, or during a sudden shortage of fresh milk, 
as may occur during a strike or severe storm when trans- 
portation is interrupted. But you should not use a pre- 
pared infant food for any length of time without your 
doctor's order. 

If you are confronted with the necessity of choosing 
a prepared food, for temporary use, you may be guided 
by considering the general objects and principles of 
baby feeding and the character of the various foods at your 
disposal. 

The proprietary foods may be divided into two general 
groups : one kind contains milk powder and is usually added 
to water, while the other consists largely of sugar and 
starch and is added to fresh milk before being given to 
the baby. 



THE MOTHER'S CARE OP HER BABY 179 

Canned milk is of two kinds; evaporated, which is un- 
sweetened, and condensed, which is sweetened. Evaporated 
milk is whole milk from which part of the water has been 
removed, the milk then being canned and sterilized. The 
addition of water to evaporated milk restores it to the com- 
position of whole milk in many respects, but it is still milk 
that has been heated. Condensed milk is evaporated milk 
to which cane sugar has been added to aid in its preserva- 
tion. Since bacteria do not grow well in highly sweetened 
foods, it is not necessary to bring sweetened condensed milk 
to as high a temperature as the unsweetened product, to 
prevent subsequent bacterial decomposition. The high per- 
centage of sugar in condensed milk quite obviously renders 
it unsuitable for continuous use as the sole article in a 
baby's dietary. 

Milk powders or dried milks are prepared by rapidly 
evaporating the water from whole milk, skimmed milk or 
partly skimmed milk, leaving the solid constituents in the 
form of a light, white powder. Milk powder readily dis- 
solves in water, forming a ''reconstructed milk'' which 
closeh^ resembles the fresh milk from which it was pre- 
pared. But it must not be forgotten that reconstructed 
milk has been heated. Many doctors consider whole milk 
powder the most satisfactory form of preserved milk which 
is available for baby food. Should it be used, however, 
the importance of keeping it tightly covered and in a cold 
place must be recognized, for the presence of fat renders 
it likely to become rancid if not kept cold. 

ARTICLES OF FOOD WHICH ARE SOMETIMES INCLUDED 
IN THE BABY'S DIETARY 

Barley water, sometimes used to dilute whole milk, is 
made by mixing the barley flour to a smooth paste in cold 
water, adding boiling water and boiling for twenty minutes 



180 GETTING READY TO BE A MOTHER 

or cooking in a double boiler for an hour, straining and 
adding enough water to replace the amount lost in cook- 
ing. The proportions for different ages are as follows : 

Three months, V2 level tablespoonf ul barley flour to 16 oz. water. 
Six months, l 1 /^ level tablespoonf uls barley flour to 12 oz. water. 
Nine months, 3 level tablespoonf uls barley flour to 10 oz. water. 

Potato Water. One tablespoonful of thoroughly boiled 
potato is mashed into one pint of the water in which the 
potato was boiled and carefully strained. 

Spinach. Spinach is carefully washed, steamed for half 
an hour and mashed through a fine sieve. It is sometimes 
started at the sixth month ; one teaspoonful daily, gradually 
increased to one or two tablespoonfuls daily. 

Orange Juice. The orange should be dipped in boiling 
water and wiped on a clean towel before being cut and 
squeezed, to avoid possible infection of juice. It is usually 
given to babies, sometimes as young as one month old, who 
take heated milk. It is carefully strained and started grad- 
ually by giving one teaspoonful in water once or twice daily 
between feedings and increasing to % or 1 ounce by the 
sixth month and 1% to 2 ounces by the end of the first 
year. 

Infusion of Orange Peel. This is sometimes used instead 
of orange juice, and is made by boiling one ounce of finely 
grated orange peel in two ounces of water, adding a little 
sugar to counteract the bitter taste and adding enough 
sterile water to bring it up to two ounces. 

Tomato Juice. Canned tomato strained through a fine 
sieve, is sometimes given to a baby a few weeks old, starting 
with one teaspoonful and gradually increasing to four to 
six ounces daily. 

Whey. One quart of whole milk heated to 98° F. or 
100° F. and one half ounce of liquid rennet or one junket 



THE MOTHER'S CARE OF HER BABY 181 

tablet stirred into it and allowed to stand half an hour 
or until firm and solid, is poured into a cheesecloth bag 
and allowed to drain for about an hour without being 
squeezed. 

Protein Milk. The curd from one quart of milk, which 
remains after the whey is drained, as directed above, is 
mashed through cheesecloth in a fine wire sieve, with a 
potato-masher or bowl of a spoon and the curd washed 
through with one pint of water. A pint of buttermilk is 
added and the mixture boiled while being stirred con- 
stantly. This is sometimes given in diarrhea. 

Beef Juice. One pound of thick round steak, slightly 
broiled, is cut into small pieces and the juice expressed 
with a meat press or a lemon squeezer, the amount varying 
from 2 to 3 ounces. It may be diluted with an equal 
amount of warm water, or slightly warmed by being placed 
in a cup standing in hot water, and salted to taste. 

Broths. One pound of lean meat, all fat and gristle re- 
moved, is allowed to one pint of water. The meat is cut 
finely and put on in cold water, heated slowly and allowed 
to simmer for three or four hours, when water is added to 
replace what was lost in cooking. It is strained, the fat 
removed and slightly salted. 

Oatmeal Water. Two level tablespoonfuls of oatmeal in 
a pint of boiling water is cooked in a double-boiler for two 
hours, strained and enough boiling water to replace the 
amount lost in cooking. 

BATHING AND DRESSING YOUR BABY 

By the time you assume your baby's care he will prob- 
ably be having his daily bath in a tub. It may be given 
under a spray, however, or the doctor may prefer to have 
him sponged. The sponge bath may be given in your 



182 GETTING READY TO BE A MOTHER 

lap or on a table covered with a pad, either method being 
satisfactory if the baby is kept warm and comfortable. But 
one inclines to the idea of having the baby bathed in the 
lap for he seems happier there ; more comfortable and less 
frightened and we cannot be sure that these factors are 
unimportant to even a tiny baby. 

The best time for the daily bath, during the first three 
or four months, is about an hour before the second feeding 
in the morning. After this age the full bath is sometimes 
given before the six o'clock feeding, in the evening, for a 
bath at this hour is soothing and restful and often helps 
toward giving the baby a good night. 

Preparation for the bath should be made with its possible 
effects, both good and bad, in mind, for the baby may be 
helped or harmed according to the skill with which he is 
bathed. He must not be chilled during his bath, and fatigue 
and irritation must be avoided by giving it quickly and 
with the least possible handling and turning. These ends 
may be served by conveniently arranging all of the articles 
which will be needed, on a low table at the right hand side 
of your chair, before the baby is undressed. 

There should be a pitcher of hot and one of cold water ; 
a bath thermometer ; two soft washcloths ; soft towels ; bath 
blankets; Castile, or some other mild soap; boracic acid 
solution; sterile cotton pledgets; large and small safety- 
pins, or large ones and a needle and thread if the band is 
to be sewed on ; unscented talcum powder ; sterile albolene 
or olive oil ; soft hair brush and a complete outfit of cloth- 
ing. The little garments should be arranged in the order 
in which they will be put on, the petticoat slipped inside 
the dress, and in cold weather, all hung before the fire or 
heater, to warm. 

The temperature of the room should be about 72° F. 
and if it is possible to bathe the baby before an open fire 



THE MOTHER'S CARE OF HER BABY 183 

or a heater, so much the better. In any case he must be 
protected from drafts and a sheet hung over the backs of 
two straight chairs will serve very well as a screen if no 
other is available. 

The tub or basin should be about three-quarters full of 
water at 100° F. for the new baby; about 95° F. after the 
third month and gradually lowered to 85° F. or 90° F. for 
the baby a year old. The temperature of the water should 
not be guessed at, but tested with a thermometer, though 
in an emergency you may safely use water that feels com- 
fortably warm to your elbow. 

Lay a folded towel in the bottom of the tub, before be- 
ginning, as babies are often frightened by coming in con- 
tact with the hard surface. 

It is a good plan to wear a waterproof apron, covered 
with one of flannel over which is laid a soft towel, until the 
bath is finished. The towel is then slipped out, leaving the 
dry, flannel apron to wrap about the baby. Wash your 
hands thoroughly with hot water and soap, before begin- 
ning; sit squarely, with your knees together, on a chair 
without arms ; take the baby in your lap and undress 
him under a blanket. In order that the bath may be 
given deftly and quickly it is well to bathe the different 
parts in the same order every day, for practice makes 
perfect. 

It is usually a routine to weigh the baby every morning, 
during the first two or three weeks and once or twice a 
week afterwards, though premature babies and those who 
are frail are sometimes weighed at longer intervals because 
of the inadvisability of disturbing them so often. The baby 
is undressed for his bath, wrapped in a blanket, and laid 
in the scoop or basket of a beam scale and a note made 
of the entire weight, for if he is placed in the scales without 
protection he is likely to be chilled and frightened. The 



184 GETTING READY TO BE A MOTHER 

weight of the blanket is ascertained separately and deducted 
from the total thus giving the baby's exact weight. 

The eyes should be bathed first, with pledgets of sterile 
cotton dipped in warm boracic acid solution, each pledget 
being used but once. To prevent the solution from running 
from one eye into the other, the baby's head is turned 
slightly to one side and the lower eye wiped gently from 
the nose outward. The lids may then be separated by 
placing one thumb below the brow and lifting it slightly, 
and the eye flushed with a gentle stream by squeezing a 
freshly soaked pledget just above it. The head is turned to 
the other side and the eye on that side bathed in like 
manner. 

The mouth is swabbed out very gently with boric-soaked 
cotton wrapped about the tip of the little finger, care being 
taken not to injure the delicate mucous lining. The nos- 
trils are cleaned with little spirals of cotton dipped in 
mineral oil or olive oil. 

The face is then washed with warm water, no soap, and 
patted dry. The scalp, neck and ears are washed with soap 
and water and thoroughly dried by patting and by wiping 
gently in the creases. The body should then be soaped with 
your hand, only one part being uncovered at a time in 
order to avoid chilling. 

To place the baby in the tub, slip your left hand under 
his head in such a way that it will rest upon your wrist 
as your fingers spread out to support his shoulders. Your 
thumb naturally curves over and holds the upper part of 
the baby's arm without pulling or straining it. Grasp his 
ankles with the right hand and lower the little body into 
the water, feet first, as shown in Fig. 50. This gradual 
lowering of the baby into the water is worth while, for 
he is likely to be frightened if he is plunged in suddenly. 
If the baby's arm and shoulder are firmly held and sup- 




185 



186 GETTING READY TO BE A MOTHER 




Fig. 51. — Method of comfortably supporting the baby's head above 
the water while giving his bath. 



ported by your left hand, it is an easy matter to steady 
his entire body and keep his head out of the water while 
giving the bath with your right hand, as in Fig. 51. 

The new baby is not usually kept in the tub for more than 
two or three minutes, but when he is three or four months 



THE MOTHER'S CARE OP HER BABY 187 

old he may stay in for five minutes and still longer as he 
grows older. 

Hot water should never be poured into the tub after the 
baby has been placed in his bath but cold water is often 
added, for a three or four months old baby, or the warm 
bath followed by a quick sponge with cold water. The 
little body is quickly patted dry, afterwards, and rubbed 
briskly with the palm of the hand; the legs and arms 
stroked toward the body ; the back from the neck down- 
ward and the chest and abdomen with a circular motion. 
Babies who react well to cold baths are benefited by them, 
but those who do not, may be harmed. Such "toughening" 
methods, to be beneficial, therefore, must be adjusted very 
carefully to the individual baby and should be employed 
only in accordance with the doctor's directions. 

The genitals should be bathed and dried with care; in- 
spected daily and any unusual appearance reported to the 
doctor. It is not uncommon for girl babies to have a 
slight bloody discharge from the vagina. Although this 
is unimportant and soon disappears, your doctor should be 
told of any discharge, however slight. The doctor often 
wishes to have the foreskin of boy babies retracted every 
morning at the time of the bath, by gently rubbing it 
back with gauze or cotton, taking pains that it is pulled 
forward to the original position after the part underneath 
has been thoroughly bathed with boracic acid solution. If 
retraction is impossible after several daily attempts, the 
baby is not infrequently circumcised. 

The care of the baby's teeth is a part of the bath and 
should begin when the first tooth appears. It should be 
wiped front and back with a piece of gauze or cotton dipped 
in boracic acid or soda solution or some other weak alka- 
line wash, to neutralize the acid secretions of the mouth 
as these favor decay. After the baby has five or six teeth, 



188 GETTING READY TO BE A MOTHER 

the use of a very soft brush with tooth paste is often 
advised, the teeth being brushed with a circular motion or 
from the gums toward their edges. The teeth should be 
wiped, or brushed, morning and evening and after feed- 
ings. The reason for such close care of the temporary teeth 
is that they serve as a mold or brace to hold the jaws in 
proper shape for the permanent teeth which appear later. 
If the "milk" or first teeth decay or crumble away before 
the jaws are developed to the point when the permanent 
teeth appear, these second teeth are likely to be crowded, 
crooked and uneven. 

After all of these details have been attended to and 
the entire body, including creases and folds, has been 
patted quite dry, it may be dusted with an unscented tal- 
cum powder, but this powdering must not be resorted to as 
an aid in drying the skin. In order to prevent chafing, 
the buttocks and thighs should be wiped clean with oil, or 
bathed with warm water, no soap, patted dry and powdered 
or oiled each time that the diaper is changed. 

The cord has dropped off, in all probability, by the time 
you begin to bathe your baby, and the navel so well healed 
that you need do nothing to it, but you may be interested 
to know what painstaking care the nurse has given to this 
important detail of the baby 's toilet. The form and method 
of cord dressings vary somewhat with different doctors 
but in practically all cases the dressings are sterile, to 
prevent infection, and porous in order that air may gain 
access to the cord and promote the drying process. The 
dressing itself may consist of dry, sterile gauze or gauze wet 
with alcohol wrapped about the cord, as shown in Fig. 
52 ; or it may consist of squares of sterile gauze or muslin 
with holes in the centers to fit around the cord, and dusted 
with some such powder as boric acid, bismuth or salicylic 
acid and starch. The dressed curd is laid flat on the abdo- 



THE MOTHER'S CARE OF HER BABY 189 

men and directed upward to prevent its being wet with 
urine ; a gauze sponge is placed over the dressing and the 




Fig. 52. — Cord dressed with dry sterile gauze. (From photograph 
taken at Johns Hopkins Hospital.) 

flannel binder applied, being sewed on or held in place 
with safety-pins, as shown in Fig. 53. 

The band is put on firmly and with even pressure, but 
not tightly. It is a mistake to think that a tight band 



190 GETTING READY TO BE A MOTHER 

strengthens the baby's abdominal muscles, for it has quite 
± the opposite tendency and in addition may give pain and 




Fig. 53. — Straight flannel binder applied over cord dressing. 



even cause vomiting. The band- is removed every morning 
at the time of the bath, or whenever it is soiled, but the 



THE MOTHER'S CARE OF HER BABY 191 

cord dressing is not usually taken off unless it is soiled. 
When the cord finally drops off, the straight flannel binder 
is replaced by a knitted band with shoulder straps. This 
is usually worn for three or four months, particularly in 
cold weather, to provide a little extra warmth over the 
abdomen. Thin, delicate babies sometimes need this band 
for a year or more. 




Fig. 54. — Putting on the diaper which has been folded straight 
through the middle. 

After the band has been applied, the warmed shirt is put 
on and then the diaper. There are two methods of putting 
on the diaper. 

One is to fold the square diagonally and bring the diag- 
onal fold around the baby's waist. One of the lower cor- 
ners is drawn up between the thighs, the two corners from 
the sides brought over this, straight across the waistline 
and not carried down between the thighs. The fourth 
corner is brought up over these and all are pinned se- 
curely with a safety-pin, while two other safety-pins hold 
the margins of the diaper together above the knees. The 
other method is to fold the diaper straight through the 



192 GETTING READY TO BE A MOTHER 

center, forming a rectangle twice as long as it is wide ; 
to lay the baby on it lengthwise, draw the lower half up 
between his thighs as shown in Fig. 54, and pin it on each 
side at the waistline and above the knees. (See Fig. 55.) 

In either case the diaper must be put on smoothly and 
care taken to avoid forming a thick pad^between the thighs 
as this will tend to curve the bones of legs, which, as you 
know, are still soft. Squares of soft, absorbent material, 





Fig. 55. — How the diaper in Fig. 54 looks after it has been put on. 

which may be burned, when soiled, placed inside the dia- 
pers will greatly facilitate the laundry work. 

The baby's diaper should be changed whenever it is wet 
or soiled, for in addition to making him restless and fret- 
ful for the time being, the skin about the thighs and but- 
tocks will grow red and chafed if he is allowed to wear 
wet diapers. Wet diapers should not be dried and used 
again but washed with mild soap, boiled and whenever 
possible, dried in the open air and sunshine. All of this 
makes it apparent that the regular use of waterproof 
protectors is to be condemned since a baby so protected 
may wear a wet diaper for some time before it is discov- 
ered. Under special circumstances such as a drive, a 



THE MOTHER'S CARE OF HER BABY 193 

short journey or visit the diaper may be covered by water- 
proof drawers but their habitual use will make the baby 
unhappy and uncomfortable and may even result in a 
serious condition of the skin. 

Coming back to dressing the baby, after his bath, we 
find that after the band, shirt and diaper have been ad- 
justed the petticoat and dress arc put on with the fewest 
possible motions and the baby's hair brushed upward from 
his neck and back from the forehead. He should be 
wrapped in a small blanket, fed and laid quietly in his 
crib to sleep. If his hands and feet are cold a hot-water 
bottle at 125° F. with a flannel cover, may be placed beside 
him. 

When the baby is made ready for the night he may have 
a sponge bath or simply have his face and hands sponged 
with warm water, according to the wishes of the doctor. 
The clothing which the baby has worn during the day 
should be entirely replaced. The day and night clothing 
may be worn more than once, if clean and if aired between 
times, but it is better not to have the baby wear the same 
set of clothes for twenty-four hours at a stretch. In cold 
weather a tape is often run through the hem of the stock- 
inette or flannel nightgown in order that it may be drawn 
up, bag fashion, to keep the baby's feet warm. During 
very warm weather the baby sleeps in a thin cotton slip. 

YOUR BABY'S CLOTHES 

Your baby's clothes were made long since, of course, but 
a word about their use is worth while as they may be very 
influential in promoting the baby's well-being. In order 
that his body may be kept at an even temperature the 
warmth of his clothing must always be adjusted to the 
needs of the moment. The general tendency is to dress the 



194 GETTING READY TO BE A MOTHER 

baby too warmly and the usual result is that he perspires ; 
is listless, pale, and fretful ; sleeps badly ; is susceptible 
to colds and other infections and has poor recuperative 
powers. His digestion is likely to be deranged and he may 
have prickly heat. On the other hand, if the baby is not 
dressed warmly enough his hands and* feet will be cold 
and his lips blue; he will cry from discomfort and the 
general result may be lowered vitality and disturbed diges- 
tion. If the baby's clothes are not comfortable, if they 
pull and drag or have tight bands, he will be fretful and 
restless, with disturbed sleep and upset digestion in con- 
sequence. 

The little wardrobe will be entirely adequate, under 
ordinary conditions, if it consists of shirts, bands, diapers, 
flannel petticoats, dresses, nightgowns, flannel wrappers 
and sacques. As the petticoats and dresses are cut twenty- 
seven inches long, many doctors feel that they offer enough 
protection for the feet of the average baby to make stock- 
ings unnecessary until he is from four to six months old. 
The skirts are then shortened to ankle length and stockings 
added to the baby's attire. Other doctors think it wiser to 
put knitted socks or part wool stockings on the new baby, 
particularly if he is born during cold weather. 

When the baby begins to creep, he should wear soft 
soled shoes, part wool stockings in cold weather and thin 
cotton or silk ones during the summer, and firm but flexible 
soled shoes as soon as he tries to stand alone or to walk. 

During the first month or two the baby scarcely needs 
special clothing for outdoor wear as he may be wrapped 
in one of the flannel squares with a casing run in one cor- 
ner to form a hood, or he may be placed on a square diag- 
onally and the upper corner folded about his head and 
held under the chin with a safety-pin. The corners on the 
sides are folded about his shoulders, the lower one brought 



THE MOTHER'S CARE OF HER BABY 195 

up over his feet and limbs and the additional blankets 
tucked in over all. But as the baby grows older and moves 
about in his carriage, he will need a cap and cloak or wrap 
with hood attached. In cold weather the cap should be 
knitted or wool lined and the cloak of soft woolen material 
or wool lined. In moderate weather the cap may be of one 
thickness of cotton or silk, or very light flannel, while on 
very warm days he will need no head covering at all. 

To sum up: The baby's clothes should be simple in de- 
sign, hang from the shoulders, fit smoothly but loosely and 
have no constricting bands; they should be of soft, light, 
porous material ; their warmth always adjusted to the im- 
mediate temperature so that the baby will be protected 
from being either chilled or overheated. And his clothing 
must always be clean and dry. 

AIRING YOUR BABY 

An abundance of fresh air is one of the baby's greatest 
needs as it increases his resistance to disease and his recu- 
perative powers, improves his appetite and aids digestion. 
In general, the more the baby is in the open air and the 
more fresh air he has while in the house, the better. 

The two factors which must be considered in supplying 
the baby with fresh air are the condition and vigor of the 
baby himself and the immediate temperature and state of 
the weather. His age and the season of the year can be 
only partial guides because of the difference between in- 
dividual babies of the same age and the variations in tem- 
perature, winds and moisture during any one season. 

The air of the room which the baby occupies should be 
changing constantly in order that it may always be fresh, 
but the temperature should be equable and the baby pro- 
tected from drafts. As the tendency here, as with the 



196 GETTING READY TO BE A MOTHER 

baby's clothes, is toward overheating, you will do well to 
remember that the young baby who lies covered up in his 
crib, may usually be kept in a colder room than is advis- 
able for an older one who is creeping or walking about. 

During cold weather the baby's bed should not be di- 
rectly in front of an open window and he should be pro- 
tected from direct currents of cold air by a sheet hung 
over the head and side of his crib. 

Two or three times daily, while the baby is out of the 
room, the windows should be opened wide to air the room 
thoroughly, one of these airings being just before the baby 
is put to bed for the night. 

The doctor's usual instructions concerning the tempera- 
ture of the nursery are to keep it from 68° F. to 70° F. 
during the day and about 65° F. at night, during the first 
three months and lower it gradually to 64° F. during the 
day and about 55° F. at night as the baby grows older. It 
is customary to begin to open the nursery window at night 
when the baby is three or four months old, if he is well and 
the temperature is above freezing. 

In planning to take the baby out of doors it is wiser, 
as a rule, to begin with the indoor airing when he is about 
a month old, except, of course, during the moderate or mild 
months of the year, when he is taken out at once. If the 
weather is cold, the baby may be protected with extra wraps 
and carried in the arms, into a room in which the windows 
are open and kept there for fifteen or twenty minutes. 
This indoor airing is increased by being gradually length- 
ened to two or three hours and by having the windows 
opened wider and wider. By the time he is two or three 
months old he is taken out of doors on clear, bright days, 
the best time being between ten and three o'clock, when the 
sun is high. If he is carried in the nurse's arms at first 
the warmth of her body serves as a protection and helps to 



THE MOTHER'S CARE OF HER BABY 197 

accustom him to the out-of-door life, when he spends a good 
deal of his time out of doors in his carriage. 

On windy, stormy days or when there is melting snow 
on the ground, the baby may be given his airing on a pro- 
tected porch or in a room with the windows open. He is 
not usually taken out if the temperature is below freezing 
until the third or fourth month. After this time the 
average baby is taken out when the temperature is not 
lower than 20° F. 

AVhen the baby is dressed in his extra wraps he must be 
taken out of doors or the windows opened immediately, for 
otherwise he will become overheated and be in danger of 
chilling when taken into the colder air. 

Warm hands and feet, a good color and the baby's tend- 
ency to sleep most of the time while out of doors are evi- 
dences of his being adequately clothed for his airing, while 
the reverse is true if he is not warm enough. 

A robust baby who has been gradually accustomed to 
being out of doors during the day will usually be much 
benefited by sleeping out at night. But he must be pro- 
tected from winds and his clothing so arranged that he can- 
not be chilled. Knitted or flannel sleeping garments or 
sleeping bags (See Fig. 20) are valuable and in addition, 
the blankets which cover the baby should be securely pinned 
to the mattress with safety-pins and tucked well under 
it at the sides and foot. The baby should wear a warm cap 
and the bed should be warmed before he is put into it. Or 
better still, he may be dressed for the night, put to bed in 
a warm room and the crib then moved out on the sleeping- 
porch. 

An excellent device for protecting the baby's arms and 
chest, and keeping him generally well covered, is the poncho 
(Fig. 56) devised by Dr. Lucy Porter Sutton of Bellevue 
Hospital. The poncho is a rectangle made of flannel, out- 



198 GETTING READY TO BE A MOTHER 

ing flannel or an old blanket and cut large enough to tuck 
well under the head and sides of the mattress and extend 
below the baby's feet. The baby's head slips through an 
opening, which is almost a right-angled slit, equally distant 
from the sides of the poncho and about 20 inches from 




Fig. 56. — The ' l Sutton Poncho ' ' which keeps even a restless baby 
well covered. The insert shows how to make the slit for his head to 
pass through. The regular bedding is turned back in this picture. 
(From a photograph taken at Bellevue Hospital.) 



the top. The slit is firmly bound and provided with tapes 
to tie it together after the baby is put in. The poncho 
should be put on loosely enough to permit the baby to move 
about at will beneath it. After it is adjusted the bed is 
made up as usual with additional blankets. 

Under all conditions the baby's airings must be increased 



THE MOTHER'S CARE OF HER BABY 199 

gradually, both as regards lowering the temperature and 
lengthening the time, and always adjusted to the vigor and 
reaction of the individual baby. He must be warm, but 
not too warm; he must be protected from wind and dust, 
and his eyes shielded from glare and from flickering light, 
such as may be caused by a tree in a light breeze. 

EXERCISING YOUR BABY 

Although the baby should not be handled unnecessarily 
nor tossed about and played with by friends and relatives, 
it is important that his muscular development be promoted 
by regular and carefully planned exercise. It is usually 
considered best for the baby to lie quiet and undisturbed in 
his crib most of the time during the first three or four 
weeks. Dr. Griffith begins the baby's exercise about that 
time by having the nurse or mother take him in her arms 
on a pillow and carry him about for a few moments several 
times daily. After a week or two of this form of exercise 
the baby is carried in the arms without a pillow but with his 
head and back carefully supported as the nurse is doing 
in Fig. 57. The position of the baby's body is changed by 
his being carried about in this way and the movement of 
the nurse or mother as she walks, causes a certain amount 
of motion of the baby's muscles which constitutes a gen- 
tle exercise. The baby should be carried first on one arm 
and then on the other in order that both sides of his body 
may be equally exercised. 

This semi-passive form of exercise by means of being 
carried about is regarded by many doctors as almost indis- 
pensable to the baby's welfare. There is a possibility 
that lack of this form of "mothering" is one reason why 
babies in institutions sometimes fail to progress as they 
should. Certainly, it is inadvisable for the baby to be al- 
lowed to' lie for very long in one position. 



200 GETTING READY TO BE A MOTHER 

By the third or fourth month the baby sits up in his 
mother's arms, as she carries him about, and he may be 
placed on the outside of his crib coverings for a little 




Fig. 57. — Method of carrying baby to support his head and back. 



while every day, to kick and struggle at will. His skirts 
should be rolled up under his arms, or removed entirely, to 
leave his legs quite free, care being taken that the room is 
warm and that he has on stockings. 



THE MOTHER'S CARE OF HER BABY 201 

By about the sixth month he will usually begin to make 
an effort to creep, if turned over on his stomach and helped 
a little, and he may be propped up in the sitting position, 
in his crib, for a few moments every day. As he gives evi- 
dence of having enough energy to creep farther than the 
limits of his crib permit, he may be put into a creeping 
pen, or upon the floor under certain conditions. It must be 
remembered that the floor is likely to be cold, drafty and 
dusty. You should assure yourself, therefore, that the 
floor is warm and that all drafts are cut off, and then spread 
a clean sheet or quilt on the floor before the baby is put 
down to creep. When the sheet is taken up, be sure that 
it is folded with the upper surface inside in order that 
when it is again put down the baby will play on that side 
and not on the side that has been next the floor. 

A creeping pen or eariole or some such provision is often 
more satisfactory than the floor, consisting as it does of a 
railed-in platform raised about six or eight inches from the 
floor. 

The suggestions for exercise, like those for the baby's 
airing, must be very general since it should always be ad- 
justed to the powers of the individual baby and directed 
by the doctor. 

TRAINING YOUR BABY 

Bowels. It is possible to train even a very young baby 
to have regular, daily bowel movements ; and this training 
should be started when the baby is about a month old. At 
the same hour each day he may be laid on a padded table, 
or taken in your lap, a small basin being placed against or 
under the buttocks and a soap stick introduced an inch or 
two into the rectum and moved gently in and out. This 
slight irritation will usually result in the baby's emptying 
his bowels almost immediatelv. Another method is to 



202 GETTING READY TO BE A MOTHER 

hold the baby in a comfortable, reclining position, on a 
small chamber in your lap, as in Fig. 58 or with his back 
supported against your chest, and the desire to empty his 
bowels stimulated by using the soap stick as described. (A 
soap stick is simply a piece of soap about three inches long 
whittled down to about the size and shape of a lead pencil 
with a blunt point.) 




Fig. 58. — A comfortable position for the baby who is being trained 
to use a chamber. 



It is of considerable importance that the position and 
method which are adopted, be employed at exactly the same 
time each day in order to establish a habit. If this is done 
and the baby is being properly fed, it will usually be found 
that before he is many months old, his bowels will move 
freely and regularly without the stimulation of the soap 
stick and only when he is resting on the small chamber 
or basin that he is accustomed to using. This establish- 
ment of a regular bowel movement not only simplifies the 



THE MOTHER'S CAKE OF HER BABY 



203 



laundry work and the care of the baby but is of great 
moment to his health. 

Thumb Sucking. It is scarcely necessary nowadays to 
tell a mother that her baby must not be allowed to suck 
on an empty bottle or a pacifier nor be permitted to suck 
his thumb. These habits are very dirty and help to spread 




Fig. 59. — Stiff cuffs on the baby 's elbows keep him from sucking 

his thumbs. 



disease. The baby may swallow air while practicing: them, 
with colic as a result, and he may so deform the shape of 
his upper jaw that later in life, the upper and lower teeth 
will not meet as they should for satisfactory mastication; 
his front teeth may protrude in a disfiguring manner ; and 
by narrowing and elongating the roof of his mouth, the 
structure of the air passages may be altered, with respira- 



204 GETTING READY TO BE A MOTHER 

tory troubles and adenoids as a probable consequence. 
Thumb sucking may be prevented by the simple pro- 
cedure of putting stiff cuffs on the baby's elbows, such 
as are shown in Fig. 59, and which make it impossible for 
him to reach his mouth with his thumb. These cuffs are 
easily made by covering pieces of cardboard with muslin 
and attaching tapes with which to tie them on the baby's 
arms. Another method is to put the baby's hands into 
celluloid or aluminum mitts made for this purpose, or little 
bags made of stiff, heavy material, which in turn are tied 
to his wrists; or his sleeves may be drawn down over his 
hands and sewed or pinned with safety-pins. It should 
be borne in mind that a baby sometimes sucks his thumb 
because he is hungry or thirsty and will give up the 
practice when his food is increased or when he is regularly 
given water to drink. 

Ear pulling is not uncommon among young babies and, 
if allowed to continue, a long, misshapen ear may result. 
This may be prevented by using a thin close fitting cap 
which ties under the chin, or by using the same kind of 
elbow splints as for thumb sucking. 

Crying". It is very easy to allow the baby to develop the 
crying habit but very difficult to break it up. The first 
step toward prevention is general good care, for a baby 
who is properly fed and exercised, kept dry and warm, but 
not too warm, and whose clothes are comfortable, will 
usually cry very little if wisely handled in other respects. 
But a baby may cry because he is hungry, thirsty, wet, 
cold, overheated, sick or in pain or simply because he wants 
to be taken up and entertained and has learned that the 
way to realize his wish is to cry. By examining the baby's 
condition and observing his habits, it is usually possible to 
discover the cause of his crying. Very often a drink of 
fairly warm water will quiet him, particularly at night. 



THE MOTHER'S CAKE OF HER BABY 205 

But unless he seems to have colic and stops crying because 
of the relief due to the upright position in your arms, you 
should hesitate to take the crying baby up and carry him 
about and hold him when it is discovered that this atten- 
tion stops his crying. 

Persistent crying should be reported to your doctor as 
it may be of some significance. 

KEEPING YOUR BABY WELL IN SUMMER 

Notice that 1 say keeping him well. There was a time 
when we looked upon the scourge, variously known as 
"summer complaint," "summer diarrhea" and ''cholera 
infantum" as a seasonal visitation that was to be accepted 
with resignation. But happily those dark days are past, 
for though the condition itself is a complicated one, the 
one big factor in its causation was dirty milk — milk that 
was infected or spoiled or both — given to a baby whose 
forces were lowered by the heat. 

It is perfectly clear, then, isn't it, that a baby is no 
more likely to be ill during the summer than at any 
other time, if he is given proper care, the kind of care 
that we have been going over in detail? Each of these 
details is important but just bear in mind that during warm 
weather it is particularly urgent to: 

1. Feed the baby properly. 

2. Keep him clean. 

3. Keep him cool. 

4. Keep him quiet. 

The end and aim of these precautions is to prevent dis- 
turbance of the baby's digestion. As babies surfer from 
the heat more than adults do and are often excessively ir- 
ritated and exhausted on warm days, these results of the 



206 GETTING READY TO BE A MOTHER 

heat are sometimes enough to upset his digestion unless he 
is safeguarded with greatest care. 

It is much the same as with grown people, who often 
find that their digestions are upset solely by their being 
tired or excited. 

The baby should have maternal nursing if .possible, dur- 
ing the summer, for breast-fed babies fall victim to summer 
complaint much less frequently than de bottle babies. 
Quite evidently, then, you should regulate your own life 
with even more care than usual — for the baby's sake. He 
should be fed with absolute regularity, and as a rule, no 
matter what the nature of his food, it should be reduced 
one quarter to one third in amount when the days are very 
hot, and he should have an increased amount of cool, boiled 
water to drink. His weight may increase only slightly, 
or even stand still for a short time, as a result of his de- 
creased food, but you need not worry about this if he keeps 
well, for the important thing is to avoid digestive disturb- 
ances. It is just the same as with grown people who are 
advised to eat less and lighter food than usual, while the 
weather is very warm, in order to keep well. 

Cleanliness, as at other times, applies to the baby's 
food, clothing and surroundings. Many doctors think it 
safer to have all milk boiled during the summer, and of 
course expect scrupulous cleanliness in its preparation and 
administration. 

The baby's soiled napkins should be placed immediately 
in a covered receptacle containing water, or a disinfecting 
solution and not left for even a moment where they may 
be reached by flies. They should be washed, boiled and 
dried in the open air and sunshine as promptly as possible. 

The baby should be protected from flies and mosquitoes 
by screens in the windows and netting over his crib and 
carriage, both because these insects make him restless and 



THE MOTHER'S CAKE OF HBK BABY 207 

irritable and because flies, particularly, arc carriers of 
filth and disease — the kind of disease thai kills so many 
babies during the summer. Accordingly, you should re- 
gard flies with deadly fear. 

The baby should be kept away from dusty places and 
from cats and dogs. And since he will put his fingers into 
his mouth, in spite of you, it is a wise precaution to wash 
his hands several times a day. 

The baby should be in the country, in the mountains or at 
the seashore, if possible during the warmest part of the 
summer at least, but if he is in town there is much that 
you can do to keep him cool and comfortable. His cloth- 
ing at this season must be adjusted to his condition and 
the temperature of the moment just as it is in cold weather. 
A thin shirt, band, diaper and cotton slip will usually be 
enough for out-of-door wear, while in the house he may 
often dispense with the slip, and sometimes with everything 
but his diaper. 

It is usually best to take the baby out of doors early 
in the morning and late in the afternoon, but to keep him 
indoors during the warmest part of the day, when it is 
likely to be cooler inside than out, particularly if the 
blinds are closed. 

During excessively hot days, the baby will usually be 
more comfortable if he has two or three cool sponge baths, 
in addition to the soap and water bath, one of the sponges 
being given just before he is put to bed for the night. He 
should sleep on a firm mattress, preferably curled hair 
but never feathers, and in the coolest, best ventilated room 
available. 

He must not be played with, held on hot laps nor sub- 
jected to the entertainment and attention which well-mean- 
ing but misguided mothers and friends are so eager to lavish 
on a hot, fretful baby. 



208 GETTING READY TO BE A MOTHER 

Prickly Heat. Very often during warm weather a fine 
rash, known as "prickly heat" or heat rash, appears on 
the back of the baby's neck and spreads over his head, 
neck, chest and shoulders. As this rash is due to too warm 
clothing or to the hot weather or to both, less clothing and 
frequent baths will often give relief. If the baby is very 
uncomfortable he may be greatly soothed by being im- 
mersed, for two to four minutes in baths, at the tempera- 
ture he is accustomed to, containing soda, bran or starch 
in the following proportions: 

Soda Bath. Two tablespoonfuls of baking soda to one gallon 
of water. 

Bran Bath. A cheesecloth bag about six inches square, partly 
filled with bran, is soaked and squeezed in the bath until the 
water is milky. 

Starch Bath. About a cupful of cooked laundry starch to one 
gallon of water. 

The baby should be placed in the tub as for his daily 
bath and his entire body submerged, as shown in Fig. 60, 
care being taken that his ears are above the surface of the 
water. 

No soap should be used while the baby has prickly heat 
and after the bath he should be patted thoroughly dry and 
powdered with some such soothing powder as the follow- 
ing: 

Powdered starch one ounce 

Oxid of zinc one ounce 

Boracic acid powder 60 grains 

Diarrhea. If your baby has an increase in the number 
of his movements, or if they become watery in character, 
something is wrong. It may be only a mild disturbance 
or it may be the beginning of an attack of summer diarrhea, 



THE MOTHER'S CARE OF HER BABY 209 

and as at first you cannot possibly tell which it is, you must 
not take it lightly. Notify your doctor at once, but if 
you are remotely situated or he is delayed in communica- 
ting with you, there are certain helpful things that you can 




Fig. 60. — Method of holding- the baby in the tub to keep all but his 
head covered, in giving a bran, starch, soda or mustard bath. 



do for the baby while waiting for the doctor. The first 
is to give an enema of half a pint of water, at 110° F., 
containing % teaspoonful of salt. (See Fig. 64, page 217, 
for method of giving enema.) If the baby seems to have 



210 GETTING READY TO BE A MOTHER 

only a slight diarrhea it may be enough to reduce his food 
one half, whether he is breast-fed or bottle-fed, and to give 
him an abundance of cool boiled water to drink. If he 
is bottle-fed it is a wise precaution to make up his formula 
with skimmed milk and leave out the sugar. 

If the baby has frequent loose movements; seems fever- 
ish ; vomits and cries as though he had pain, stop all food 




Fig. 61. — Putting the baby into a wet pack. 

and give nothing by mouth but water, until the doctor 
comes. 

If you care for your baby, yourself, through an attack 
of summer complaint you will find that the doctor's in- 
structions are directed toward keeping the baby cool, clean 
and quiet, while he, himself, gives very careful attention 
to the question of feeding. 

It is clear, then, that the baby should be lightly clad 
and kept quiet and undisturbed, in a cool shady place, out 



THE MOTHERS CARE OF HER BABY 211 

of doors as much as possible. During the warmest part 
of the day. however, he will often be better off in the house. 
in a room with the shutters dosed. But while keeping the 
baby eool, you must bear in mind the harm that may be 
done by chilling him or exposing him to a cold draft or 
wind. The doctor may want him to have several baths 
daily, possibly tub baths, at a temperature of 100° F., 
or cool sponge baths. Packs, also, are given, for they not 
only cool the baby but quiet him as well, if he is restless. 




Fig. 62. — The baby in a wet pack with a hot-water bag at his feet 
and cold compress on his head. 

These packs may be cool (80° P.) ; tepid (100° P.) or hot 

(105 c to 108° F.) according to the baby's needs. 

It is a simple matter to give a pack and you will enjoy 
doing it for you will actually see that your baby will grow 
quieter and more comfortable as you give it. Cover the 
bed with a rubber and sheet and bring to the bedside a 
basin containing a sheet wrung from water of the specified 
temperature ; a basin containing ice and compresses for the 
baby's head and a flannel covered hot-water bottle at 125° 
F., for his feet. The baby is laid on the upper half of the 
folded wet sheet, and an upper corner wrapped about each 
arm. as in Fig. 61, and the sides folded around his legs. 
The lower half is brought up between his feet and used to 



212 GETTING READY TO BE A MOTHER 



cover his entire body, being tncked around his shoulders. 
The hot-water bottle is placed at his feet and an ice com- 
press on his head, as in Fig*. 62. If the sheets are wrung 
from warm or hot-water, the baby is covered with a blanket 
after he is put into the pack. 





Lower half of shee 
token up between 
legs (feet not 
covered) to cover 
body completely 
andis tucUed unde 
shoulders 



Corners of sheet* 
wrapped .around arms 



Sides of sheet 
wrapped, around leds 



Fig. 63. — Diagrams showing the successive steps in putting the baby 

in a pack. 

Should your baby have summer complaint, remember that 
even a mild attack predisposes to another and you will have 
to be even more watchful and painstaking than ever, in 
your care of him. He will have to return to his customary 
diet very slowly, or he may not be able to take his usual 
amount of nourishment at all until the weather turns cool. 
Even though he gains no weight it is important to avoid 
taxing his digestion since it is already being threatened by 
the heat. 



THE MOTHER'S CARE OF II KK BABY 213 

KEEPING YOUR BABY WELL IN WINTER 

There are certain evils that beset the baby's way during 
the winter just as there are seasonal pitfalls in summer, 
but the truth is that if you care for yourself and him ac- 
cording to the suggestions that have 1 been set down in the 
foregoing pages, you are doing practically everything nec- 
essary to make his way safe and comfortable. A baby who 
has proper food, plenty of fresh air, is kept clean and 
whose daily life is regular, is not likely to be ill during 
the winter or any other time. 

The chief baby ills that come with the blustery weather 
are colds and the troubles that are likely to follow in their 
wake, such as bronchitis and pneumonia. Colds are infec- 
tious, you know, so keep the baby away from sneezy peo- 
ple and out of crowds and dusty places. If he should take 
cold in spite of you, send for the doctor at once. It may 
amount to nothing and clear up in a day or two, but if you 
let it run on, the dreaded bronchitis or pneumonia may 
result. 

RELIEVING COLIC, CONSTIPATION AND CONVULSIONS 

I have tried to impress upon you, at every step, that it is 
very unwise for you to delay in sending for the doctor 
when your baby seems ill, or to attempt to treat him ac- 
cording to your own ideas or those of your neighbors. But 
if the baby should begin to scream with colic or have a 
spasm, you would want to know what to do at the moment, 
and in case of constipation there are a few simple nursing 
procedures that you may employ to the baby's advantage. 

Colic is always due to indigestion, whether the baby is 
breast-fed or bottle-fed, because of the food itself being 
wrong in some respect or because it is not properly given. 



214 GETTING READY TO BE A MOTHER 

The milk may contain too much of the material that forms 
the curd, or so much starch and sugar that fermentation 
takes place, the pain itself usually being due to undigested 
food or gas in the intestines. This condition may also 
result from the baby's being fed too rapidly or too fre- 
quently, or from his swallowing air while sucking on a 
pacifier or an empty bottle. Colic may be caused, too, 
by chilling the baby as this is likely to disturb his diges- 
tion. 

Most babies have colic at some time during the first year, 
usually before the fifth month. The attacks may occur 
several times a day, after feeding, or they may not come 
on until the late afternoon or evening when the baby is 
tired. Colic is so common that most people are familiar 
with the symptoms: violent crying and a flushed drawn 
face ; cold hands and feet ; tightly clenched fists and a hard, 
swollen abdomen. As the pain is cramp-like, the baby 
stops crying every little while, and then suddenly begins 
again, drawing up his legs, doubling up his body and 
then straightening out with a jerk. 

For immediate relief, you may give the baby a table- 
spoonful of hot water in which half a soda mint tablet has 
been dissolved, and an enema of half a pint of water, at 
110° F., containing one half teaspoonful of salt, given 
through a small rubber tube introduced about six inches. 
This empties the lower bowel and enables the baby to expel 
a good deal of the gas that is troubling him so. Rub his ab- 
domen with a little oil and apply a compress of several 
thicknesses of flannel, wrung from hot water, covering this 
with a larger piece of dry flannel, and change it every three 
or four minutes for a while. Place a flannel covered hot- 
water bottle (at 125° F.) at his feet, cover him warmly, 
darken the room and he will almost certainly go to sleep. 
It is often a good plan to substitute barley water for one 



THE MOTHER'S CAKE OF HER BABY 215 

or two feedings, after an attack of colic, in order to give 
the disturbed digestive tract a rest. 

Quite naturally, you must tell your doctor if your baby 
has colic for the cause may lie in the character of his food. 
But it may lie in some error on your part. Go over all 
the details of your share of the baby's care and see if you 
can discover anything to correct. 

With breast-fed babies, prevention is often accomplished 
by the mother's nursing her baby more slowly, lengthening 
the intervals between nursings and by improving her own 
hygiene, particularly by relieving constipation and increas- 
ing her recreation and out-of-door exercise. Nursing 
mothers who lead sedentary lives and eat rich food very 
often have colicky babies as do those who are nervous, 
irritable and inclined to worry. 

If the baby is bottle-fed he may be taking his food too 
fast because of an over-large hole in the nipple ; he may 
not pause often enough during his meal or he may take 
in air as he nurses because the bottle is not properly held, 
as shown in Fig. 48. 

In any event do not stop until you get at the cause of the 
trouble for though the colic itself may not necessarily be 
serious, a continuation of the cause may result in a run 
down condition or even in malnutrition. 

Don't forget the importance of holding the baby upright 
over your shoulder after each feeding, to help him bring up 
gas, and of placing him immediately in his crib to be left 
quiet and undisturbed. And ask your doctor about drink- 
ing water. Very often the tendency toward colic is les- 
sened by increasing the amount of cool boiled water given 
between meals. 

Constipation is very common among babies and may be 
manifest by the stools being too small, too dry or too infre- 
quent. It is more difficult to cope with than colic, though it, 



216 GETTING READY TO BE A MOTHER 

too, may have its origin solely in unsuitable food. In some 
cases, however, the constipation is due to absence of habit 
in emptying the bowels regularly; to weakness of the in- 
testinal muscles; to long-continued undernourishment or 
to some such disease as rickets. 

It becomes apparent, that the prevention of this trouble- 
some condition is accomplished largely by giving suitable 
food; constant fresh air; regularity in the daily routine 
and training the baby to empty his bowels at the same 
time every day. 

When constipation is due to insufficient fat in the food, 
cod-liver oil is sometimes given, 15 to 30 drops three or 
four times a day ; or a teaspoonf ul of olive oil two or three 
times a day. Maltose, malt soup, malted milk, milk of 
magnesia, mineral oil, oatmeal water and orange juice are 
all found among the remedies for constipation ; while soap 
sticks, suppositories and enemas of oil or soapsuds some- 
times have to be resorted to. 

In giving an enema to relieve constipation, the baby 
should be protected from chilling, laid on a pillow and the 
bedpan so placed that he will be comfortable and not in- 
clined to move, and from half a cup to a cup of soapsuds, 
at 105° F., given with a small hard-rubber nozzle, as in 
Fig. 64. When warm olive oil is given at night (2 to 4 
tablespoonfuls slowly through a small rubber tube intro- 
duced about six inches), it is very often retained until 
morning when the baby empties his bowels freely with 
little or no assistance. 

Abdominal massage will often relieve constipation by 
strengthening the intestinal muscles, this in turn tending 
to make the bowels move. The abdomen should be rubbed 
with a firm but not hard, circular stroke, beginning in the 
right groin and working up to the margin of the ribs, across 
to the left side and down to the groin. This massage is 



THE MOTHER'S CAKE OF HER BABY 217 

often given for about ten minutes every day, preferably 
at night, but never just after feeding. 

Constipation is sometimes entirely cured by nothing 
more than a suitable dietary ; an abundance of drinking 




Fig. 64. — Giving the baby an enema. He is well protected, to 
prevent chilling, and lies comfortably on a pillow which reaches to 
the bed-pan, the latter being covered with a diaper where he rests 
upon it. 



water ; an out-of-door life ; massage, and above all, the 
unceasing effort to establish a regular habit. These are 
all things which you, yourself, may do for the baby. The 
longer constipation persists, the harder it is to cure, so do 



218 GETTING READY TO BE A MOTHER 

all in your power to prevent it and if it develops, try to 
end it at once. 

Convulsions are a symptom of several disorders of in- 
fancy and they may occur unexpectedly. Although at the 
moment, they are more distressing than serious, you should 
notify your doctor at once. If he cannot come promptly 
you may end the seizure by employing measures that will 
quiet and relax the struggling baby. The room should be 
darkened, kept absolutely quiet and the baby handled with 
the utmost gentleness. As a rule the most satisfactory 
course is to immerse the baby in water at 100° F. and keep 
him there for five or ten minutes, supporting his head above 
the level of the water as shown in Fig. 60. (See p. 209.) 
Have some member of the household place cloths, wrung 
from cold or iced water, on the baby's head and change 
them frequently. When removed from the bath, the baby 
should be wrapped in a blanket, kept very quiet and the 
cold applications to his head continued. 

If the baby often has convulsions the doctor may instruct 
you to give him either a mustard bath or pack whenever he 
has an attack. 

For a bath, one ounce, or six level tablespoonfuls of dry 
mustard is added to one gallon of water at 105° F. and the 
baby kept in it for about ten minutes, or until the skin is 
well reddened. He is then wrapped in a warm blanket 
and surrounded by hot-water bottles, with cold compresses 
applied to his head. The mustard pack is given in the 
manner shown in Figs. 61 and 62, with a sheet wrung from 
mustard water which is possibly a little warmer and 
stronger than that for the bath, care being taken that the 
sheet is not cooled before it is wrapped about the baby. 
He is usually left in the pack for about ten minutes or 
until his skin is reddened, and then wrapped in warm 
blankets, with cold compresses to his head. 



THE MOTHERS (ARE OF HER BABY 219 

THE PREMATURE BABY 

All of the precautions and gentleness which are necessary 
in the care of the normal baby, born at term, must be 
greatly increased in caring for the baby who is born pre- 
maturely. The premature baity is not only small, but in 
general is imperfectly developed, having slenderer powers 
than the full term baby, and at the same time much greater 
needs. His respiratory and digestive organs are less ready 
to act than those of the normal baby: bis muscles and 
nerves are feeble ; his heat-producing machinery is unstable 
and yet he loses an excessive amount of body heat. 

Accordingly, the baby who has been deprived of those 
valuable last weeks of growth and development within the 
uterus, is small and limp; lies quietly most of the time: 
moves very feebly, if at all. and needs special care. To help 
him in maintaining a normal body temperature it is usually 
necessary for him to be oiled with warm olive oil and 
entirely wrapped in cotton batting or flannel or enveloped 
in a quilted garment, with hood attached, made of cheese- 
cloth or tiannel and cotton batting, such as is shown in 
Fig. 65. Diapers are often omitted in caring for very 
feeble babies, a pad of rot ton, instead, being slipped under 
the buttocks, as this may be changed with less disturbance 
to the baby than a diaper. 

A satisfactory bed may be devised from a basket or box 
with the bottom well padded with several inches of cotton, 
a small pillow or a soft blanket folded to the proper size, 
covered with rubber or oiled muslin and a cotton sheet. 
The sides of the basket may be lined with heavy quilted 
material, to shut out drafts and help to preserve an even 
temperature of the air immediately around the baby, or 
such a basket as is shown in Fig. 66 may be used. A 
flannel covered hot-water bag at 110° F. may be placed 



220 GETTING READY TO BE A MOTHER 

beside the baby, or two, three or four glass bottles, each 
holding about a pint, containing water at 100° F. and 
securely stoppered, may be hung in the corners of the 
basket. A thermometer, also, should hang in the basket 




Fig. 65. — Quilted robe, with hood, for the premature baby. It 
may be made of flannel or cheesecloth with cotton batting for the 
padding. 

and the temperature kept between 80° F. and 90° F. 
The temperature varies less if the bottles are filled in 
rotation than if all are reheated at the same time. 

The amount of heat needed around the baby is decided 
by taking his temperature (by rectum) at regular intervals; 
supplying more heat if the temperature is low and less if 
it is at or above normal. Some doctors have the tempera- 
ture taken every four hours; others twice daily. As the 




Fig. 66. — An improvised bed for the premature baby, consisting 
of a closely woven clothes basket with padded bottom and four 
flannel-covered bottles of hot water, attached to the sides. The 
necessary thermometer and special feeder are shown in the basket. 
(By courtesy of Dr. Alan Brown, Hospital for Sick Children, 
Toronto.) 



221 



222 GETTING READY TO BE A MOTHER 

baby grows able to maintain a temperature of 98° F. to 
100° F., unassisted, the surrounding heat is gradually 
reduced and finally removed, and flannel clothing replaces 
the quilted robe. 

The basket in which the baby lies should be placed in a 
darkened, well ventilated room and should be carefully 
screened from drafts. As the baby needs moist air there 
should be a large, open vessel of water in the room. 

Since the premature baby 's lungs are not fully expanded, 
respirations are likely to be shallow and irregular, thus fail- 
ing to supply the amount of oxygen which he needs. And 
as crying always causes deep breathing, it is a common 
practice to make the baby cry at regular intervals during 
the day. 

In feeding the premature baby, breast milk is the most 
desirable food. In fact, many doctors feel that his life 
virtually depends upon it. If the baby is too feeble to 
nurse, the milk may be expressed from the mother's breast, 
being immediately covered and placed in the refrigerator 
unless used at once. Breast milk is sometimes used whole 
and sometimes diluted with sterile water and is often given 
from a medicine dropper or through a special feeder. Such 
a feeder consists of a glass tube with a small nipple on one 
end and a rubber bulb on the other, by means of which the 
milk may be gently expressed into the baby's mouth. (See 
Fig. 66.) 

The premature baby's bath is of considerable importance. 
It almost always consists of sponging him with warm olive 
oil as he lies in his bed and with the least possible exposure 
and turning. It is given every day or every second or 
third day, according to his condition. The eyes are wiped 
with boric pledgets and the nostrils with spirals of cotton 
dipped in oil. The buttocks are wiped with an oil sponge 
each time the diaper is changed. 



THE MOTHER'S CARE OF HER BABY 223 

It must be borne in mind constantly that the premature 
baby is particularly susceptible to infection. He should 
be safeguarded by having everything that comes in contact 
with him scrupulously clean; being protected from drafts, 
chilling and dust, and allowing no one with a trace of a 
cold to come near him. The person who cares for him 
should wear a freshly laundered gown and protect her nose 
and mouth with a gauze mask while attending him. 

TRAVELING WITH YOUR BABY 

Babies should not travel; that is obvious. But if a 
journey is unavoidable, the attendant difficulties and dis- 
advantages may be greatly lessened by making certain 
preparations. If the baby is bottle-fed, the preparations 
will depend upon the length of the journey and whether or 
not it will be possible to have freshly prepared feedings, for 
each twenty-four hours, put on the train from laboratories 
along the way. If this is not possible and the journey is not 
to take more than twenty-four hours, the entire quantity 
of food, ice cold, may be carried in a thermos bottle. The 
requisite number of sterile nursing bottles may be taken or 
one bottle which is boiled before each feeding. Or the milk 
may be prepared as usual and the bottles packed in a port- 
able refrigerator. Such a refrigerator may be bought or 
one may be improvised. The bottles are placed in a covered 
pail and packed solidly in crushed ice; this is placed in a 
second pail or a box with a diameter which is at least two 
inches larger than the inner pail and the space between the 
two packed firmly with sawdust. Several thicknesses of 
newspapers should be pressed down over the top and a tight 
cover fitted to the outer receptacle. 

The sterile nipples may be taken in a sterile jar and a 
deep cup or kettle will be needed in which to warm the 



224 GETTING READY TO BE A MOTHER 

bottle before each feeding. It is usually possible to obtain 
water on the train which is hot enough for this, or cans of 
solid alcohol, a stand and a metal tray may be added to 
the traveling outfit. If fresh formulae cannot be delivered 
to the train, daily, and the journey is to last more than 
twenty-four hours, one of the proprietary foods or a pow- 




Fig. 67. — If traveling is unavoidable the baby will be comfort- 
able and undisturbed in a basket converted into a bed. (By courtesy 
of the Maternity Centre Association.) 

dered milk will often prove to be a satisfactory solution 
to the problem of feeding the baby while traveling. The 
course to be followed, however, should be selected by your 
doctor. 

The baby will usually travel more comfortably and sleep 
better if he is carried in a basket. A large market basket 
with a handle or a small clothes basket will serve. It may 
be lined with a sheet or a blanket ; have a small hair pillow 
or folded blanket in the bottom and be made up like a crib. 
(Fig. 67.) If this basket stands on the car seat during the 



THE MOTHER'S (ARE OP HER BABY 225 

day, and on the foot of your berth at night, the baby will 
be cleaner, quieter and less exposed to drafts than if carried 
in the arms. 

As we look back over these pages of somewhat detailed 
description of the baby's care it is borne in upon us that 
the nursing of this unfailingly delightful and engaging 
little person has special adjustments and adaptations for 
different seasons and circumstances. But that on the whole 
the care of all babies, the year round, resolves itself into 
the observation of a few general principles, namely: proper 
feeding; fresh air, rest and quiet: regularity in the daily 
routine; cleanliness of food, clothing and surroundings; 
preservation of an even body temperature ; consultation 
with the doctor at regular intervals and also whenever the 
baby seems ever so little ill. 

If you are guided constantly by these general principles 
and apply them conscientiously, you may revel in the satis- 
fying consciousness that you are keeping your pledge to 
your baby by giving him the best possible start on his life's 
journey. 



CHAPTER XI 
THE NUTRITION OF MOTHER AND BABY 

Perhaps you are wondering, just a little, why I devote 
even a short chapter to the subject of nutrition when I 
have already given you suggestions about dietaries for 
yourself and your baby. I am doing so because this ques- 
tion of nutrition is one of such enormous importance in 
relation to the baby's future well-being that I want to give 
it special emphasis. 

It is probably safe to say that the two most influential 
factors in creating and maintaining a satisfactory state of 
health are suitable nutrition and the prevention of infec- 
tion. Although we shall concern ourselves solely with 
nutrition, in this chapter, it may be stated in passing that 
a state of good nutrition goes far toward protecting one 
from infection. 

It will help to make the entire matter clearer to explain 
in the beginning that a state of good nutrition is not neces- 
sarily evidenced by one 's being tall nor by being fat. But 
it is evidenced by normal size and development ; sound teeth 
and bones ; hair and skin of normal color and texture ; blood 
of the normal composition ; stable nerves ; vigor both mental 
and physical; normally functioning organs; resistance 
to disease, and above all that indescribable condition which 
is summed up as a state of general well-being. 

That this degree of nutritional stability is not as preva- 
lent in this country as might be desired is disclosed by 
reports upon findings of the examining boards for army 

226 



THE NUTRITION OF MOTHER AND BABY 227 

service, over a period of three years, and physical examina- 
tions of various groups of school children throughout the 
country. It was found in the first case, that about sixteen 
per cent, of the apparently normal young men who were 
inspected for military service, were undernourished in some 
degree, and according to Dr. Thomas \V. AYood, Professor 
of Physical Education, Columbia University, "Five mil- 
lion children in the United States are suffering from mal- 
nutrition." This army of undernourished children, which 
represents about one third of the children of the country, 
is on the broad highway to ill health, invalidism of various 
kinds and degrees, instability and inefficiency. They are 
certainly not developing into the clear-eyed, alert, buoyant 
individuals that go to make up good citizenry. 

The tragic aspect of this state of undernourishment is 
that though a great deal can be done to nourish and build 
up the malnourished child or adult, a certain amount of 
damage that results from inadequate nourishment during 
the early, formative weeks and months cannot be entirely 
repaired later on in life. 

As the baby grows and develops, certain substances are 
needed at the various stages of his progress, and if these 
are not supplied at these stages, there will always be some 
degree of inadequacy in the adult make up. It is much like 
the futility, when building a house, of using bricks without 
straw for the foundation instead of firm, durable rock, and 
then trying to make the structure substantial and secure 
later on by using good materials when building the upper 
stories. 

The solid foundation and substantial beams and girders 
for men and women are put in during infancy and early 
childhood in the shape of good material that forms good 
nerves, muscles, bones, teeth and general physical stability. 
It is practically impossible to make up to the older child or 



228 GETTING READY TO BE A MOTHER 

adult for damage caused by failure to supply sufficient 
nourishment to the growing*, developing, infant body. 

"The moving finger writes ; and, having- writ, 
Moves on; nor all thy piety nor wit 
Shall hire it back to cancel half a line, 
Nor all thy tears wash out a word of it." 

We see all about us, the results of this form of neglect of 
babies, in the bow-legged, knock-kneed, undersized, mis- 
shapen, chicken-breasted adults and in those who are nerv- 
ous and below par in endurance ; are susceptible to colds and 
other infections and may be summed up as being "not 
strong. ' ' 

The reasons for much of the undernourishment among 
people in this country to-day are to be found in certain 
widespread misconceptions of long standing as to what 
constitutes a state of good nutrition or malnutrition and 
the value and purposes of different foodstuffs. For mal- 
nutrition does not necessarily describe a simple condition 
due to an insufficient amount of food, but to any one of 
several complex conditions due to a lack in the food of one 
or more essential substances. 

One may eat a large amount of food and even have a 
well-padded body and yet be seriously in need of certain 
food factors — in other words, be incompletely nourished in 
some particular. 

That was possibly the first misconception — the belief that 
one simply needed enough food, and accordingly was well 
nourished if three large meals were eaten daily, irrespective 
of the composition of those meals. A step forward was 
taken when housewives and people generally accepted the 
fact that quantity alone was not enough to consider in pro- 
viding food, but that the dietary should consist of balanced 
amounts of the five food materials; fats, carbohydrates, 



THE NUTRITION OF MOTHER AND BABY 229 

proteins, minerals and water, in order to build and maintain 
the body in a state of health. 

But this, too, was found to be an error, in so far as it was 
only a part of the truth, for it was next ascertained that 
even provision for a suitable balance of the five food groups 
was not enough to nourish us, but that we must consider 
the heat-and-energy-producing properties of these com- 
ponent parts, as measured by the caloric unit, and that we 
must daily take in the requisite number of calories if we 
would keep our engines going. 

It is now known that even this is not enough, for we may 
eat food in ample quantities, consisting of the properly 
balanced fats, proteins, carbohydrates, minerals and water, 
and it may daily yield the required number of calories, and 
still We may suffer from seriously faulty nutrition. 

We find an explanation for this fact in the comparatively 
recent recognition of three substances, as yet not clearly 
understood, which are contained in a certain few articles 
of food, each one of which is essential to growth and normal 
health and well-being, though not necessarily concerned in 
the production of heat or energy. Various terms have been 
applied to these mysterious, but necessary substances, such 
as vitamines, accessory food substances, as applied to all, 
or fat-soluble A, water-soluble B and water-soluble C to 
designate them separately. 

A surprisingly small amount of each of these substances 
is sufficient to meet the needs of an individual, but no one 
of these, even in this small amount, can be safely dispensed 
with, for if the diet is deficient, or lacking in one or more 
of them some form of nutritional disturbance will result. 
It may be severe enough to be diagnosed as a disease, or it 
may be only enough to keep the individual below a normal 
state of health. 

When the disturbance is profound enough to produce a 



230 GETTING READY TO BE A MOTHER 

definite, recognizable condition, it is designated as a de- 
ficiency disease, of which there are three : scurvy, beri-beri 
and xerophthalmia. With these are sometimes included 
rickets and pellagra. The exact cause of the two latter 
disorders is not definitely known but both are associated 
with faulty nutrition. Poor hygienic conditions may enter 
into the causation of rickets, and infection may be a factor 
in the occurrence of pellagra, but neither disease appears 
in people who are suitably fed while both diseases may 
be produced by faulty diet and both may be cured with 
suitable food. 

But probably of graver importance to the public welfare 
than the well defined nutritional disturbances, themselves, 
is the fact that between a state of good health and the level 
upon which a disease is recognizable is a long scale, along 
which is ranged an uncounted army of under-par, half- 
sick people. These are the ones who are tired, nervous, sus- 
ceptible to infections, with feeble recuperative powers, and 
in general are more or less ineffective in the business of life. 

It is this borderline state, or as Dr. Goldberger terms it, 
"the twilight zone," which cannot quite be called disease 
but is not health, that is serious to the masses, for diagnosed 
disease is given treatment, but nervousness, lack of energy 
and endurance, weakness and inefficiency are not treated; 
as a rule they are merely tolerated. The sufferers fail to 
reach their highest possible development and they fail to 
be of highest value to society. 

This is the condition which can be so largely prevented by 
giving the baby a good nutritional foundation. This must 
be started during his prenatal existence, carried through 
the nursing period and then continued throughout the rest 
of his life. 

It will mean much to the coming generation if the ex- 
pectant and nursing mothers at large are able so to com- 



THE NUTRITION OF MOTHER AND BABY 231 

pose their diets that they will provide not only the requisite 
fats, proteins, carbohydrates, minerals and water and yield 
the necessary calories, but will contain, also, all three pro- 
tective substances: fat-soluble A, water-soluble B and water- 
soluble C. It can be demonstrated that when these food 
factors are not present in the mother's diet, they will not 
appear in her milk, and accordingly will not be supplied to 
her baby. 

That is the crux of the whole question. If your diet is 
faulty, your milk will be faulty in the same respect and 
your baby, being incompletely nourished, will start life 
with tissues that are lacking in those substances that are 
needed to make them sound and to promote health. That is 
what we have in mind when we say that the mother's milk 
must be satisfactory not alone in quantity but in quality 
as well, if the baby is to be well nourished. 

In order to make quite clear how damaging are the 
results of diets which are deficient or lacking in protective 
substances we shall have a word about rickets and scurvy. 
the two diseases due to faulty diet, that are so serious for 
babies. 

Rickets is a nutritional disturbance, common among 
babies who are fed solely or continuously on heated milk, 
either boiled or canned, and on proprietary food and sweet- 
ened condensed milk. Rickets may develop, also, among 
nursing babies whose mothers are on faulty diets. 

The chief characteristics of the disease are arrested 
growth and softening of the bones, with dwarfism and de- 
formities as a result. It is essentially a disease of infancy, 
occurring as a rule, between the fourth and eighteenth 
months but some of its unfavorable effects, such as bone 
deformities and poor resistance to disease, may persist 
throughout life. Although babies rarely die of rickets 
alone, it is one of the most serious of all health problems 



232 GETTING READY TO BE A MOTHER 

since it predisposes to such diseases as bronchitis, pneu- 
monia, tuberculosis, measles and whooping cough and in 
general greatly weakens the powers of resistance and 
recuperation. 

The common, early symptoms of rickets are irritability; 
restlessness, particularly at night ; a tendency to have con- 
vulsions from very slight causes ; digestive disturbances and 
profuse perspiration about the head. The baby may be fat, 
but is likely to be flabby and have a characteristically white, 
"pasty" color. The fontanelles are large and late in clos- 
ing; the abdomen is large and the chest narrow; teething 
is usually delayed and the teeth may be soft, when they 
do come in, and decay early. But the most conspicuous 
effect of rickets is upon the bones which are soft, easily 
bent and broken and often misshapen. Their growth is 
likely to be retarded and the ends of the long bones may be 
enlarged, causing swollen wrists and ankles and the little 
lumps on the chest, so commonly called a ' ' rickety rosary. ' ' 
The bones in the arms and legs may become curved as the 
baby lies or sits in his crib, making him either bow-legged 
or knock-kneed. Since the soft bones are easily bent their 
deformity is increased by the baby's walking or by the 
bunch which may be formed between the thighs by a large, 
improperly applied diaper. The spinal column may be 
curved, or too weak to permit the baby to sit straight or 
stand alone. The entire chest wall is often deformed, pro- 
ducing the familiar ' ' chicken-breast ' ' and so decreasing the 
size of the chest that the baby's breathing space is cut 
down. This is one reason why pneumonia is so serious 
with a baby who has, or has had rickets. The forehead is 
prominent and the whole head looks square and larger than 
normal, while the pelvic deformities in girl babies often 
give rise to very serious obstetrical complications later 
in iife. 



THE NUTRITION OF MOTHEK AM) BABY 233 

All of this, with the misery which it entails, is due to 
faulty nutrition. 

The sovereign remedies in rickets are eod-liver oil and 
sunshine, in addition to general good care. But the 
treatment is a long, slow process, taking from three to fif- 
teen months, and it is doubtful if the damage which the 
disease works can ever be repaired. 

Rickets is more common during the cold months of the 
year, winter and spring, than during the milder summer 
and autumn seasons. A possible explanation for this lies 
in the higher value of the cows' food during the warm 
months when green things form the diets of animals. Since 
it is now recognized that milk is noi a constant product, 
but that its properties vary with the food of the animals 
that produce it, cows' milk would be favorably influenced 
by their being put to pasture. 

Similar evidence of such an influence is seen in the fact 
that although rickets is not seen among breast-fed babies 
whose mothers are on satisfactory diets, it may and does 
occur in breast-fed babies who are nourished by mothers 
who are, themselves, on dietaries which are poor in milk 
and fresh fruit and vegetables. 

It is quite plain that a baby who is fed and cared for in 
accordance with the suggestions offered in the preceding 
chapters is not likely to develop rickets. 

Infantile scurvy is seen among babies who are fed solely 
on milk that has been heated, boiled, pasteurized or canned, 
since the vitamine, in milk, that prevents scurvy is practi- 
cally destroyed by heating or aging. That is one reason why 
it is dangerous to give stale milk to babies and why you 
should not use canned milk on your own responsibility. 
If the doctor orders it for your baby, he will know what to 
give in addition to the milk to keep the baby from having 
scurvy. 



234 GETTING READY TO BE A MOTHER 

The disease develops slowly, the first symptoms appear- 
ing between the seventh and tenth months. Tenderness or 
pain in the legs is perhaps the most common symptom and 
may be detected first by the baby's crying when his diaper 
is changed or his stockings put on. And a baby who has 
been cheerful, playful and active will prefer to lie quietly 
and will cry whenever he is touched. \He grows pale, list- 
less and weak and fails to gain in weight or length. His 
large joints are likely to be swollen and tender ; his swollen 
gums may bleed; his urine be diminished in amount and 
contain blood. But it is entirely possible for a baby to be 
in serious need of the vitamine that prevents scurvy and 
still not present these well defined symptoms of the disease. 
In such a case there may be stationary weight, fretfulness, 
a muddy complexion and perhaps tenderness of the bones. 

Scurvy, of itself, does not often cause death among 
babies, but it is serious, nevertheless, for it makes the 
babies very susceptible to infection, particularly nasal 
diphtheria and ''grip." 

The disease may be either prevented or cured by giving 
orange juice, potato water, spinach or tomato juice to a 
baby whose diet consists of milk that has been heated and 
is therefore lacking in the vitamine that prevents scurvy. 

Although scurvy is seldom seen in breast-fed babies it 
is believed that an infant who is nursing at the breast of 
a woman whose diet is lacking or deficient in fresh milk, 
oranges and leafy vegetables will suffer a certain degree of 
starvation and thus be sickly and susceptible to infection 
without actually having scurvy. 

The significance to you, of this complicated and enor- 
mously important question of nutrition may be summed up 
as follows : 

1. There are five recognized diseases resulting from faulty nutri- 
tion, which may be either prevented or cured by a diet which 



THE NUTRITION OF MOTHER AND BABY 235 

contains the protective substances, called vitamines, which are 
now regarded as essential to normal growth, development and 
well-being. 

2. These essential substances are not necessarily provided in 
adequate amounts by a diet that is satisfactory in bulk or in 
its balance of fats, carbohydrates, proteins, salts and water or 
that yields the requisite number of calories. The familiar diet 
of meat, potatoes, peas, beans, bread, pie and coffee is so far 
from providing complete nourishment that those who are 
limited to it are in a state of partial starvation. 

3. Although the breast tissues are capable of converting into 
milk certain substances which they extract from the blood, 
they cannot create the protective substances which we have 
been considering. They can merely excrete these substances 
if they are contained in the mother's diet. The absence, or 
shortage of these food essentials in the mother's diet, and 
therefore in her milk, may result in rickets or other mal- 
nourished conditions in the baby, or in a degree of faulty 
nutrition which is not marked enough to be diagnosed, but 
enough to keep him frail ; enough to give him the poor start 
that is so likely to put him, ultimately, in the class of those 
adults who are more or less unfit, though not actually ill. 

4. The great protective foods are milk and leafy vegetables and 
any diet which is poor in these is incapable of nourishing 
satisfactorily. 

By milk we mean fresh milk, first and foremost and also 
cream, butter, buttermilk, cream soups and sauces, custards, 
ice-cream and all dishes and beverages made of milk. 

By leafy vegetables we mean lettuce, romaine, endive, 
cress, celery, cabbage, spinach, onions, string beans, aspara- 
gus, cauliflower, Brussels sprouts, artichokes, beet greens, 
dandelions, turnip tops and the like. 

Other foods which are rich in protective substances are 
fresh fruit, egg-yolks and glandular organs, as liver and 
sweet-breads. 



236 GETTING READY TO BE A MOTHER 

Nearly all of the common foods are deficient in some 
respect, but as the shortcomings of the various groups are 
different, we can arrange entirely satisfactory diets by 
combining foods which supplement each other 's deficiencies. 
This explains to us why the meat-potato-peas-beans-bread- 
and-pie type of meals fail to supply adequate nourishment. 
These foods belong in the same general group and are de- 
ficient in about the same kind of food factors, thus tending 
to duplicate, rather than supplement each other. 

If such a fare is enriched by the addition of the protec- 
tive foods, milk and leafy vegetables, we have a well 
rounded diet in which the deficiencies of one group of 
foods are supplied by the properties of the other groups. 
In fact, it is only by such a supplementing combination 
that an entirely satisfactory diet can be secured. 

It is generally agreed that the two big problems of bab}- 
hood are proper nutrition and the prevention of infection, 
but nutrition is perhaps the greater problem, since any form 
or degree of malnutrition lessens the baby's powers to resist 
and to recover from infection. Whether breast-fed or 
bottle-fed, therefore, it is imperative that the baby be 
nourished in the complete sense of being given all of the 
food materials which are essential to normal growth, de- 
velopment and protection against disease. 

If your baby is artificially fed on milk that has been 
heated you will understand why the doctor adds such pro- 
tectives as cod-liver oil and orange juice, since the pro- 
tective properties of milk are impaired by heating. If he 
is breast-fed, you will be able to supply to your baby the 
requisite nourishment and protective substances only if you 
yourself are adequately nourished and in good condition. 

That is the point of this discussion; the fact that you 
must be on a satisfactory diet or you cannot satisfactorily 
nurse your baby. Satisfactory nursing means to give to 



THE NUTRITION OF MOTHER AND BABY 237 

your baby, from the beginning, through your milk, the 
materials necessary to build well and securely that temple, 
in the form of his body, which he will occupy throughout 
life ; a structure so substantially built, from the foundation 
up through each successive stage, that it will be able to 
withstand the attacks of disease and weather the inevitable 
storm and stress of life, for perhaps even more than the 
allotted three score years and ten. 

"The race marches forward on the feet of little children." 



